PDCA原理在儿科临床路径管理质量持续改进中的应用

目的分析运用PDCA原理促进儿科疾病临床路径规范实施的应用效果。方法从2018年1-5月份对急性胃肠炎、发热性惊厥、支气管肺炎3个临床路径病种实施PDCA持续改进,共699例作为观察组;并以2017年7-12月份这3个临床路径病种共624例为对照组,对比两组间各病种的临床路径入径率,平均住院日,平均住院费用,抗生素使用天数,药品比,按医嘱出院率,患者满意度进行比较、分析和评价。结果运用PDCA循环管理临床路径后,观察组平均住院日,平均住院费用,抗生素使用天数,药品比均较对照组明显降低(P <0. 05),临床路径入径率,按医嘱出院率、患者满意度较对照组明显增高(P <0. 05)。结论运用PDCA原理管理临床路径,通过加强科室管理者监管力度、建立健全的质控制度、加强医务人员对临床路径知识的培训,完善路径系统,制定有效的奖惩制度等措施,可提高临床路径入径率,能缩短住院时间,降低住院费用,合理使用抗生素,降低药品比,不断规范医师的诊疗行为,使儿科疾病诊疗过程更规范,提高医疗质量及患者满意度,值得推广应用。

Application of PDCA principle in continuous improvement of quality of paediatric clinical pathway management

Objective To analyze the application effect of PDCA principle in promoting the implementation of paediatric disease clinical pathway standard. Methods From January 2018 to May 2018,699 cases with acute gastroenteritis,febrile convulsion and bronchopneumonia treated by continuously improved paediatric clinical pathway by PDCA were selected as the observation group. From July 2017 to December 2017,624 cases with the above three diseases were selected as the control group. The clinical path entry rate, average hospitalization days,average hospitalization cost,antibiotic use days,drug ratio,discharge rate and patient satisfaction were compared,analyzed and evaluated between the two groups. Result After using PDCA circulation to manage clinical pathway,the average days of hospitalization,the average cost of hospitalization,the days of antibiotic use and the drug ratio in the observation group were significantly lower than those in the control group( P < 0. 05) . The rate of clinical path entry and discharge according to the doctor’s advice in the observation group was significantly higher than those in the control group( P < 0. 05) . Conclusion Using PDCA principle to manage the clinical pathway,by strengthening the supervision of department managers,establishing a sound quality control system,strengthening the training of medical personnel on clinical pathway knowledge,perfecting the path system,and formulating effective reward and punishment system,can increase the rate of clinical path entry,shorten the hospitalization time,reduce the hospitalization cost,use antibiotics reasonably,reduce the drug ratio,standardize the physician’s diagnosis and treatment behavior,make the diagnosis and treatment process of pediatric diseases more standardized,and improve the medical quality and patient satisfaction,It is worth popularizing and applying.