公布病案缺陷对病案质量的影响

本文阐述了病案缺陷信息公布的必要性以及信息公布的方法。通过对病案整理过程以及录入病案首页信息的逻辑检验程序中发现的缺陷内容进行分类编码登记,并按月进行统计汇总,将汇总信息用适当的方式公布,为整顿病历的缺陷提供了可靠依据,并以病案缺陷信息公布后取得的实际效果证实了病案缺陷信息公布可以促进病案质量的提高。

The effect to medical record quality of medical record defect announcement

This article discussed the necessity of medical record announcement and its method. Through sorting code number and registering the defects in the logical testing procedures of the home page and the process of medical record settling, summarizing monthly and then announcing the in- formation in an appropriate way, thus providing reliable evidence to the rectify of medical record. Finally, the actual result after the announcement can promote the improvment of the quality of medical record.