实施临床路径的反思

临床路径作为一种可以有效控制医疗服务费用和保证医疗服务质量的临床服务模式，已在我国很多医院进行了尝试。文章通过对临床路径运用于腹腔镜胆囊切除术的实施过程的反思，认为临床路径的顺利开展，需要抓住以下几个重要环节，即改变医生传统的观念、医院的大力支持及相关科室的相互协调与配合、护士树立主动服务的理念、加强与患者的沟通以及在实施过程中不断地进行变异因素的分析等。     

基于循证实践症状管理的电子护理临床路径建设

作者介绍了复旦大学附属肿瘤医院在建设电子护理临床路径的过程中融入症状管理循证实践的成果,以"化疗前全面评估""化疗相关性恶心呕吐""化疗相关性腹泻"为例,介绍循证实践在电子护理临床路径中的应用。通过项目的实施形成了规范的电子化护理临床路径操作流程;护理人员在项目实施的过程中引入了护理新工具、新流程和新技术;同时帮助降低...     

六西格玛管理在提高器械手工清洗合格率中的应用

目的探讨六西格玛管理模式在提高器械手工清洗合格率中的应用效果。方法应用六西格玛管理模式,通过界定、测量、分析、改进、控制5个阶段,对器械手工清洗过程进行规范化管理,比较实施六西格玛管理模式前后器械手工清洗合格率以及临床对CSSD的满意度。结果实施六西格玛管理后器械手工清洗合格率达96.40%,临床对CSSD的满意度为96.67%,与实施前相比,差异有统计学意义(P<0.05)。结论实施六西格玛管理可明显提高器械手工清洗质量,提高临床对CSSD的满意度。     

子宫肌瘤手术患者实施临床路径相关分析

对60例子宫肌瘤手术患者实施临床路径，通过对住院时间、医疗费用、确诊天数、治疗效果、出入院诊断符合率、病人满意度的比较，对临床路径实施效果进行分析和评价，并对临床路径实施过程中出现的困难进行讨论，针对相关问题寻找解决途径，为控制医疗费用与持续改进医疗质量提供决策依据。     

医院外来试用医疗设备使用风险的控制

外来试用医疗设备给临床科室新技术、新业务的开展提供了有力支撑,但也增加了临床诊疗过程中的风险因素。通过有效监管,制订相应制度,规范使用流程,可以有效控制此类医疗设备的使用风险。     

临床输血质量控制与关键控制点

目的确保临床输血安全有效。方法通过明晰输血程序,建立质量体系文件,提高人员素质,确定质量控制项目与关键环节。结果输血过程所涉及的仪器设备、材料、冷链、实验过程、记录等均得到有效控制。结论实施临床输血质量控制和关键控制点是血液安全最大化的重要举措。     

计算机联网后医院统计数据质量控制

1999年1月我院统计室通过全院计算机网络采用广东省卫生厅研制的<医院统计应用程序>处理全院统计数据,通过不断发现问题和解决问题,总结经验,大大提高了统计工作的及时性、准确性和完整性,但质量问题仍是大问题.计算机联网后的医院统计质量,涉及统计资料的收集、整理、审核、输入、汇总等统计工作必经环节,总体说医院统计数据质量控制过程应包括输入前、输入中、输出后三个步骤,只有进行全程的质量控制,才能高效率高质量地完成统计工作.     

分析前质量控制对尿液常规检验的临床效果探讨

目的通过尿液分析前的质量控制,分析其在尿液常规检验中的临床效果。方法 2020年3月～2020年4月,对我院1000例患者,根据质量控制实施前后进行分组,对照组400例采取的是尿液常规检验,实验组600例实施加强检验过程质量控制的尿液常规检验,比较两组患者的检验护理满意度和标本合格率。结果实施加强检验过程质量控制的实验组患者检验护理满意度明显高于对照组(P0.05),标本不合格率显著低于对照组(P0.05)。结论临床患者在实施加强尿液常规检验分析前质量控制,可显著提高标本合格率,减少不合格样本的出现,还可提高患者的护理满意度,值得临床推广和应用。     

我院科研管理的做法与体会

我院是设有16个临床科室、门急诊部、住院部和承担8所高等院校临床教学的二级综合医院.我院通过组织、协调和控制的做法对临床科研工作实施管理,以提高临床医务人员的科研能力.     

西门子放疗局域网在放疗技师工作站的应用

目的：探讨西门子放疗局域网（LANTIS）在放疗技师工作站中的应用和意义。方法：总结LANTIS在实施放射治疗过程中对于各种异常情况进行记录及处理的特点。结果：LANTIS不但可以对放疗前参数不符发出警告,而且还可以在异常中断后进行断点治疗。结论：放疗网络的应用避免了人工数据输入的误差,为放射治疗临床质量保证和质量控制提供了保障。     

医院医疗质量实时控制研究概述

目的：探索先进、有效的医疗质量的管理方法，提高医疗环节质量。方法：前瞻性方法，结合文献综述、过程分析、统计学和计算机网络技术等。结果：建立了医疗质量实时控制的要素管理、过程管理、监测控制管理模式；确定了医院病种质量与费用实时控制方法；确定了临床路径对住院诊疗质量实时控制的作用；确定了病案质量实时控制 的方法。结论：医疗质量实时控制是一种有效的新的医疗质量监管方法。     

临床新技术准入管理的研究与实践

文章从人员、机构和技术本身3个方面,全面分析了临床新技术准入管理的主要内容,系统介绍了按照分类别、分层次、分阶段准入管理的思路进行的实践探索,并对开展临床新技术带来的公平、效益和长期安全等问题进行了探讨。     

Disease management strategies: managing care giving in managed care

The rapid rate of change in health care delivery systems has challenged and troubled health care providers. Some new health care delivery systems primarily emphasize the economics of medical care and leave providers with a sense that their profession has strayed from its mission. In addition, there is an increasing demand by payers and the public for public accountability for the quality and expense of clinical services. One response to these changes in health care is the use of disease management strategies. There is a growing body of knowledge regarding disease management strategies and practice guidelines in the literature. This article discusses how a provider group can implement improvement in the clinical process successfully by applying techniques of disease management.     

规范临床新技术、新项目管理的做法与体会

探讨安徽省立医院规范临床新技术、新项目管理的做法:一是明确新技术、新项目的管理范畴和管理部门;二是抓好申报与管理的三个环节;三是管理与激励并重,实现两个效益稳步增长.并结合三年来的实践谈自身体会.     

Clinical governance and operations management methodologies

The clinical governance mechanism, introduced since 1998 in the UK National Health Service (NHS), aims to deliver high quality care with efficient, effective and cost-effective patient services. Scally and Donaldson recognised that new approaches are needed, and operations management techniques comprise potentially powerful methodologies in understanding the process of care, which can be applied both within and across professional boundaries. This paper summarises four studies in hospital Trusts which took approaches to improving process that were different from and less structured than business process re-engineering (BPR). The problems were then amenable to change at a relatively low cost and short timescale, producing significant improvement to patient care. This less structured approach to operations management avoided incurring overhead costs of large scale and costly change such as new information technology (IT) systems. The most successful changes were brought about by formal tools to control quantity, content and timing of changes.     

临床路径实践探讨：以白内障临床路径为例

临床路径是以单病种质量管理为核心的管理模式。文章以卫生部颁发的《临床路径管理指导原则》中的白内障临床路径为例进行探讨,并对实施过程中的存在问题提出建议。     

刍议临床学科评估精细化管理

目的了解临床学科发展现状,为医院学科建设总体规划提供科学依据。方珐按照精细化管理模式,积极探索临床学科评估的新途径。结果根据医院临床学科评估的实际,在工作流程、指标设置、评估简表设计、质量控制、评估结果管理、资料备案以及制定规划等7个方面积极推行精细化管理模式。结论精细化管理是一种新型的管理理念,它提倡“细节决定成败”,在临床学科评估工作中有其独特的优势。在今后的学科评估中,要进一步加强精细化管理理论的学习,以建立学科评估精细化管理长效机制。     

公立医院新增医疗服务项目申报流程实践与优化——以血液科为例

在医疗改革不断深化的进程中,医疗服务新项目的申报,将成为公立医疗机构合理化收入的有益补充。对于临床科室的新技术、新方法的经济学评估,医院的医保物价和成本管理科室的主动参与,可以通过基于成本核算的价格设置,为临床科室的学科发展和运营优化提供更为合理的引导。该文以血液科新增服务项目为例,通过分析新增医疗服务项目申报流程的实践情况,建立医院内部的申报管理流程,并在一定程度上优化现行病种支付价格,达到平衡医院、患者及政府等多方利益的目的。     

The cost management organization: the next step for materiel management

With Materiel Management's transition over the last decade from simple logistics to analysis and cost management, it has gained recognition as a key part of the management team responsible for supplies, equipment, standards, and associated processes to identify, purchase, store, distribute, issue, and dispose of supplies and equipment. The materiel manager's job consists of putting the right product in the right place at the right time and in the right quantity at the best total delivered cost. In this context, Materiel Management has made powerful impacts to lower costs associated with: Distribution--costs have been lowered by actively adopting advanced supply channel management techniques such as primary suppliers, JIT, stockless programs, case cart/custom kit/procedure based delivery systems, modified stockless programs as well as margin management through cost plus, flat fee, or margins paid per activity. Cost of goods--lowered through aggregated purchasing in the forms of regional and national purchasing alliances and local capitation or other gain/risk share programs. Internal process costs--lowered by out-sourcing and/or integrating supplier processes and personnel into operations via partnership approaches. We have also reduced transactional costs through EDI transaction sets and the emerging use of the inter and intranet/electronic commerce, procurement cards, and evaluated receipt settlement processes. De-layering--We have lowered the operating costs of Materiel Management overhead by re-design/re-engineering, resulting in reduced management and greater front line authority. Quality--We have learned to identify and respond to customer and supplier needs by using quality improvement tools and ongoing measurement and monitoring techniques. Through this we have identified the waste of non-beneficial products and services. We have adopted supplier certification measurers to ensure quality is built into processes and outcomes. With so much already accomplished, it should be easy to rest on these laurels and simply operate. However, we believe that this is just a beginning. A new generation of highly educated leaders are emerging and taking advantage of the contributions of pioneers who laid the ground work. These new leaders will have advanced management, statistics, and behavioral sciences skills. They will be analysts and organizational motivators. Their goal will be to improve financial and clinical performance measured by real time process and performance data. The new leaders will have information at their fingertips thanks to significant leaps forward in data collection, automated continuous replenishment processes, and software designed for better management of clinical and cost outcomes. This article documents significant Materiel management accomplishments and conceptualizes cost management processes. The cost management organization is the logical evolution in our efforts for better outcomes in healthcare Materiel management.