工作量为基础的手术室护士绩效方案及应用效果分析

目的探讨以工作量为基础计算手术室护士绩效的方法及效果。方法通过医院信息管理系统提取量化数据,根据"以资源为基础的相对价值比率评估系统(RBRVS)"计算手术护士工作量并转换为绩效分值。结果方案实施后整体工作时间内直接护理时间明显提升,达到总工作时间的73.22%,首台手术准时率从50.97%提高到75.11%(p<0.05),接台手术间隔时长从平均0.62小时降至0.33小时。结论建立以工作量为基础多维度评价手术护士绩效方案体现专科护士的工作特点与劳动价值,充分调动手术护士的工作积极性,有利于手术室运行效率和护士工作效率的提高。     

医院输血科选址的合理性分析

通过分析临床科室取血工作量情况及2019年12602袋血液取发血的情况,对医院的输血科的位置选择提出建议。     

The quest for interaction: studies on combined exposure

Summary A literature review was performed on the subject of combined exposure to stressors in the working situation. A general, dynamic model of workload served as the theoretical framework for the study. In this model, every factor that triggers a physiological or psychological response in the worker is regarded as a stressor. Decision latitude plays an important role in the model. A quantitative and qualitative analysis was performed on the available literature. It was concluded that the stressors that appear in studies on combined exposure stem mostly from the physical, chemical and biological environment. The task contents, the labor conditions, social relationships at work and the decision latitude are considerably less often studied in relation to combined exposure. It is concluded that important concepts in the study of combined exposure (e.g. interaction, independence, synergism, antagonism) are often quite carelessly mentioned in the literature. Explicit definition of these concepts is lacking in many publications. Establishment of maximum exposure levels is not yet possible for most stressor combinations. Examples are given of combinations that do allow more or less definite conclusions. It is recommended that more studies should be interdisciplinary organized. More studies are necessary in the field, studying effects of long exposure periods in the working population instead of studying students in laboratory situations. Exposure of susceptible groups, such as older workers and partially disabled workers, deserves special attention.     

上海市单中心儿科门诊特征和医疗服务2009至2018年趋势分析

目的 探索医院信息系统(HIS)医疗大数据处理方法,分析儿童专科医院近10年门诊患儿就诊特征及医疗服务趋势。方法 以复旦大学附属儿科医院(我院)HIS门诊患儿就诊挂号登记表的全样本数据为基础,系统地进行数据清洗(诊断、地址、重复、离群、缺失)、数据集成(数据库链接和匹配)、数据规约、数据脱敏和数据核查,行门诊患儿就诊特征及医疗服务趋势的分析。结果 2009至2018年我院门诊挂号20 775 899人次,依据纳入和剔除标准,18 242 822 人次进入本文分析;男性占57.42%,婴儿占9.57%,幼儿占40.94%,学龄前儿童占24.82%,学龄儿童占24.67%。诊断缺失率为5.92%,地址缺失率为45.31%,接诊医生姓名缺失率为26.81%,行缺失数据人群分析,各年份性别和年龄构成比差别不大。10年间门诊量年平均增长5.22%,2012较2011年增长11.22%,2014较2013年增长10.93%,2015年后环比增长均<2.90%。10年间不同年份各省市门诊量>P₇₅ 和~P₅₀的省市,从华东向西南、西北、华南、中部、东北扩大。10年间门诊医生平均日接诊51人次,初、中和高级职称医生门诊日均接诊分别63、54和45人次;专科门诊从2009年的46个发展为2018年的180个,2018年专科就诊比例达68.12%,专病门诊从2009年的16个发展为2018年的142个。结论 基于国家儿童医学中心之一的我院的门诊数据表明,10年间门诊量先快速增长后平稳增长,患儿来源地区快速从华东地区辐射至全国,门诊医生平均日接诊数量低于全国平均水平,专科门诊和专病门诊成为重要的发展趋势。     

临床医生药事服务工作量测算研究

目的探讨科学的药事服务工作量测算方法,以某三甲医院为例测算临床医生药事服务工作量,为决策者提供方法和数据支持。方法采用文献查阅、头脑风暴和专家咨询法确定测量参数和测算方法,通过调查获取药事服务工作量数据,运用SPSS 17.0软件对数据进行统计分析。结果临床医生药事服务工作量的量化参数为"工作时间"和"价值含量",不同职称和学历的调查对象对药事服务工作量的评估没有统计学差异(P>0.05)。结论药事服务工作量点数受医生职称、学历和工作地点等因素的影响较小,研究所探讨的量化参数和测算方法具有一定的可行性和科学性,但有待进一步论证和实践。     

Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country,multilevel study

BackgroundNursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.ObjectiveThe aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.DesignMultilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.ResultsRegarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.ConclusionsWe conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.     

乡镇卫生院护理人员工作现状及离职意愿研究

目的:描述乡镇卫生院护理人员工作现状和离职意愿,并分析工作量和工作内容对离职意愿的影响,为改善基层护理工作提出建议。方法:采用多阶段分层整群随机抽样,对我国三个省45家乡镇卫生院的167名护理人员进行问卷调查,并深度访谈44名护理人员。结果:深化医改以来,农村基层护理人员工作量增加,62%认为自己的工作量大。护理工作占护理人员平均工作时间的60%;公共卫生服务工作占平均工作时间的21%。30%的被调查者具有离职意愿。在控制省份、工作量、婚姻状况、编制、文化程度和从医年限等混杂因素后,公共卫生服务参与情况与护理人员离职意愿显著相关(P0.05)。结论:医改后乡镇卫生院护理人员工作内容扩展、工作量增加,工作内容的扩展降低了护理人员的离职意愿。     

社区公共卫生及基本医疗项目“标准工作当量”的测算研究及其意义

目的：通过测算社区公共卫生及基本医疗项目各种工作量的“标准计算单元”(即“标准工作当量”),并以此将社区公共卫生和社区基本医疗共84种工作量进行转换。方法根据各个项目的服务流程和服务规范,通过“作业成本法”对社区健康服务的各种工作量进行成本测算,根据不同工作量之间的人力资源成本(以“人·天”为单位),设立一个“标准工作当量”进行转换。结果选择一项具有代表性的工作量为参照单位来转换各种工作量,以社区公共卫生项目的“1人次的规划内疫苗的预防接种”或社区基本医疗项目中的“1人次的社区常见病多发病诊疗服务(西医药服务)”作为标准工作当量,把84种不同种类工作量转换成统一的计量单位。结论采用“标准工作当量”可以直接、客观地衡量社区健康服务的工作负荷,并进行财政经费分配和绩效管理。     

Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico

AimTo analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS).MethodCross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis.ResultsA response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004).ConclusionsThe results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.