医院门诊护理流程优化管理研究进展

通过对医院门诊护理流程的优化定义、护理流程优化意义中存在的服务盲区以及应对措施等存在的问题,对国内外相关的医院门诊护理流程优化管理的研究进行概述。     

门诊护理服务的现状与改进

目的医院门诊通过服务流程的现状调查,优化流程,改善服务,提高服务质量。方法优化服务流程;依托信息化建设,提高就诊效率;提供多种方式预约挂号;张贴便民服务措施;建立规范清楚的标识系统;提供人性化服务,提高就医体验;提高医护人员综合素质。结果改进门诊护理服务后,优化了服务流程,缩短了消耗在非医疗上的时间,提高了患者的满意度。结论应改进门诊护理服务,优化服务流程,缩短消耗在非医疗上的时间,提高患者满意度。     

提高社区门诊输液室护理质量的研究

目的探讨提高社区门诊输液室护理质量的方法。方法在社区卫生服务工作中，重视输液室的环境优化、护士素质培养、护理服务内容拓展、工作规范管理等。结果提高了社区门诊输液室护理质量，促进患者康复，从而进一步提高社区卫生服务工作的社会效益和经济效益。结论重视输液室的环境优化、护士素质培养、护理服务内容拓展、工作规范管理等是提高门诊输液室护理质量的优秀方法。     

临床路径在门诊采血室的应用体会

目的总结临床路径应用于门诊采血室以提高其护理质量的经验。方法制定门诊采血室的流程,并连续性给予评估和改进。结果通过规范门诊采血室的工作流程,病人的投诉率由原来的15%降至5%。结论科学的临床路径优化了门诊采血室的工作流程,对提高门诊采血室的护理质量非常重要。     

门诊开展优质护理服务的社会效果

目的探讨门诊开展优质护理服务的效果。方法通过采取完善制度、细化分工、优化就诊流程,为患者提供优质护理服务。结果工作流程规范,护理质量提高,患者满意度由实施前的90.5%提高到98%。结论门诊实施优质护理服务能为患者提供安全、优质、多层次的服务,取得良好的社会效果。     

夯实门诊优质护理服务体会

目的:探讨夯实门诊优质护理服务的措施和效果。方法:2014年1月-2015年1月,门诊护理工作夯实优质护理服务,推出优质服务举措:即优化流程、规范行为、落实便民措施、健康教育等护理服务。结果:门诊患者服务满意度达96.2%;门诊工作量较上年增加10%,门诊护理服务质量极大提高。结论:门诊护理服务是影响门诊患者满意度的重要因素,夯实门诊优质护理服务,是提高门诊患者满意度的重要举措,同时也是提高门诊护理服务质量的保障。     

输液流程优化优质护理服务在门诊输液室的应用

目的探讨输液流程优化优质护理服务在门诊输液室应用的具体措施和效果。方法 2011年1～12月实施门诊输液流程优化优质护理服务,比较实施前(2010年1～12月)后患者满意度、护理质量和护理差错发生率。结果实施后患者满意度、护理质量均高于实施前,护理差错发生率低于实施前,差异均有高度显著性(P<0.01)。结论输液流程优化优质护理服务对降低护理差错事故,提高患者的满意度和护理质量具有积极的作用。     

军队高龄老年患者PICC管门诊及社区的维护及管理

目的:探讨军队老年患者PICC管在门诊及社区的维护及管理方法。方法:建立以门诊为中枢的"病房-门诊-社区"三位一体护理管理模式,对50例置管老年患者的PICC管进行维护;同时通过健康宣教使患者及家属了解、认知维护常识,进行自我维护。结果:有效进行了PICC管的合理维护,保证了护理过程的有效性和连续性,未出现感染病例。结论:以门诊为中枢的"病房-门诊-社区"三位一体护理管理模式是一个有效的护理管理模式,合理的门诊护理流程为PICC置管患者提供了完善的全程护理,而健康宣教也起到了积极作用。     

护理流程对提高护理工作效率的作用

目的:探讨在提高护理工作效率过程中,护理流程的作用。方法:对我科15名护士的护理流程管理进行评价,分析护理工作流程的开展状况,对比护理流程优化前、优化后的工作效率结果:制定合理、规范的护理流程表,优化护理流程后,我科护理的工作时间明显缩短、差错事故发生明显减少、患者满意度明显提高,与护理流程制定、优化前相比,其差异具有统计学意义(P0.05)。结论:我科护士的护理流程进行规范、优化,有助于规范护士的护理工作,提高护理工作效率。     

优化门诊服务流程 提高门诊护理质量

目的以优化门诊服务流程和我国一再提倡的充分解决病人难为指导思想,保障门诊就诊过程安全．快速。方法给门诊病人简化流程和给予无缝隙式护理。结果患者得到了及时、准确的门诊医疗服务。结论门诊进行优化服务流程和无缝隙式服务,为患者提供了满意的服务,从而提升了门诊护理质量。     

0~3岁儿童社区儿科门诊就诊需求研究

背景　儿童“看病难”是我国儿科医疗常见问题，但社区卫生服务中心目前主要承担社区儿童的预防接种和儿童保健方面工作，儿童常见病诊疗处于“去基层化”状态，社区卫生服务机构增设儿科门诊势在必行。目的　了解0~3岁儿童的社区儿科门诊就诊需求，探讨其开展过程中的尚存问题，从而为增设社区儿科门诊提供依据。方法　于2018年3-7月，采用简单随机抽样法在月坛社区卫生服务中心、三里河二区社区卫生服务站、木樨地社区卫生服务站抽取儿童保健科门诊就诊的0~3岁儿童280例。采用研究组自行设计的问卷对纳入儿童家长进行调查，主要内容为儿童的基本信息和对社区儿科门诊需求情况。结果　共回收有效问卷270份，问卷有效回收率为96.4%。94.4%（255/270）的儿童家长认为非常需要/需要社区开设儿科门诊；若社区开设儿科门诊，92.6%（250/270）的家长愿意带儿童来就诊。目前，儿童患病后，73.7%（199/270）的家长首选到三级医院（包括儿童专科医院）就诊，20.7%（56/270）的家长首选到社区卫生服务机构就诊；儿童家长选择到社区卫生服务机构就诊的原因排在前2位的分别为距离近、就诊方便（55.9%，151/270），就诊患儿少、挂号容易（53.3%，144/270）。儿童家长认为社区儿科门诊尚需解决的问题排在前3位的分别为医生技术水平较低（77.4%，209/270）、药品不齐全（56.3%，152/270）、缺乏设备（55.9%，151/270）。61.5%（166/270）的儿童家长希望就诊时与医生交流的时间为6~10 min；81.8%（221/270）的家长认为儿童患病后应先到社区卫生服务机构就诊，根据病情由社区医生转诊至三级医院。结论　0~3岁儿童对社区儿科门诊的诊疗需求较大，多数家长愿意带儿童到社区卫生服务机构就诊，也支持分级诊疗的就诊模式，但社区卫生服务机构的整体环境、检查设备配置、医生诊疗水平、药物配备等制约了社区儿科诊疗，需要从国家、医院、社区卫生服务机构等不同层面解决。     

社区脑卒中患者各级康复准入及准出标准建立研究

背景　康复是社区卫生服务机构职能的一个重要组成部分,康复网络体系的不健全,加剧了社区的脑卒中康复需求。构建社区脑卒中康复服务体系,符合社区居民的卫生服务需求,也是基层医疗卫生机构在医疗卫生体系中功能定位的体现。目的　构建上海市社区脑卒中各级康复准入及准出标准,以指导社区筛选真正属于脑卒中康复范畴并亟须照护的人群,规范各级脑卒中患者的准入及准出。方法　于2018年4—7月,邀请18位综合医院心脑血管和康复领域专家、社区卫生服务中心脑卒中康复相关管理者和执行人代表,通过两轮Delphi专家咨询,采集各位专家对社区中心病房康复、养老机构康复、社区中心门诊康复和居家康复的脑卒中康复服务对象的准入及准出标准的意见。结果　两轮咨询专家的积极系数均为100.0%,且最后一轮专家权威程度为0.74。根据服务对象准入及准出标准的界定原则,从介入时间点、神经功能、运动功能障碍、触觉及本体感觉障碍、认知障碍、情绪障碍、语言和交流障碍、吞咽障碍、尿便障碍、日常生活活动能力和生活质量、社会支持度等方面梳理出了社区脑卒中患者各级康复的准入及准出标准。结论　本研究构建的社区中心病房、养老机构、社区中心门诊、居家四级康复服务对象的准入及准出标准可信度较高,可供社区开展脑卒中康复工作时借鉴及实际应用,同时为社区各级脑卒中康复转介机制的有序运行奠定了基础。     

Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices

CONTEXT: The US primary care safety net is composed of a loose network of community health centers, hospital outpatient departments, and physicians' offices. National data on how the mix of patients and services differ across sites are needed. OBJECTIVE: To develop and contrast national profiles of patient and service mix for primary care. DESIGN, SETTING, AND PATIENTS: Comparative analyses of 3 national surveys of primary care visits occurring in 1994: for data on physician's office visits, the National Ambulatory Medical Care Survey (NAMCS); for hospital outpatient department data, the National Hospital Ambulatory Medical Care Survey (NHAMCS); and for data on community health centers, the Bureau of Primary Health Care's 1994 Survey of Visits to Community Health Centers. A time trend analysis also was conducted using the 1998 NAMCS and NHAMCS. MAIN OUTCOME MEASURES: National estimates of primary care visit rates, types of patient presentation, patient case-mix, disposition of patients, and management interventions in 1994, and compared with 1998 data. RESULTS: The US population made 1.3 primary care visits per person in 1994, which accounted for 43.5% of all ambulatory visits to physicians' offices, community health centers, and hospital outpatient departments. Primary care visits per person were 20% lower for Hispanics and 33% lower for black, non-Hispanic persons compared with white, non-Hispanic persons. Visits to community health centers were more likely to be made by ethnic minorities, patients with Medicaid or no insurance, and rural dwellers than visits made to the other delivery sites. Visits at hospital outpatient departments were made by sicker populations and were characterized by less continuity than the other delivery sites. Controlling for patient mix, visits made to hospital outpatient departments were more commonly associated with imaging studies, minor surgery, and specialty referrals than those made to physicians' offices. In 1998, the US population made an estimated 3. 4 visits per person, 45.6% of which were primary care visits. National estimates of primary care visit rates and patient mix and practice pattern comparisons between hospital outpatient departments and physicians' offices were similar in 1998 and 1994. CONCLUSIONS: Expanding community health centers will likely improve access to primary care for vulnerable US populations. However, enhancing access to of physicians' offices is also needed to bolster the safety net. The greater service intensity and poorer continuity for primary care visits in hospital outpatient departments that we observed raises concern about the suitability of these clinics as primary care delivery sites. JAMA. 2000;284:2077-2083.     

Supporting the health care team in caring for patients with AIDS

A multidisciplinary approach to AIDS health care is described that combines skilled generalists with subspecialists in oncology and infectious disease; incorporates assistance with the social, economic, and psychological sequelae of AIDS; and taps the resources available in the patient's community to staff inpatient and outpatient clinics. Many unresolved ethical issues posed by AIDS and the stresses of AIDS care are explored. The distribution of patients with AIDS as widely as possible throughout the physician community, publication of a newsletter of practical AIDS information, participation of staff members in decision making and formation of program goals, and collaboration with therapists have helped to reduce the stress of AIDS clinic staff members at the San Francisco General Hospital.     

柳州市妇幼保健院信息化建设对门诊就诊流程的影响研究

目的：探讨信息化建设对妇幼保健院门诊就诊流程的影响.方法：采用问卷调查的方式对柳州市妇幼保健院实行医院信息化建设前后门诊患者等待时间以及就诊各环节满意度进行评价.结果：实施信息化建设后门诊服务综合满意度显著提升（χ2=116.6551,P〈0.0001）,其中就诊等待时间满意度提高幅度最大,主要表现为非诊疗时间减少、诊疗时间增加.结论：实施信息化建设对门诊就诊流程有简化作用,且主要体现在对非诊疗时间的缩短和诊疗时间的合理延长方面.     

Limiting cardiovascular risk in Irish rheumatoid arthritis patients

Background  Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease and premature death. Objectives  Our aims were: (1) to assess how thoroughly RA patients were being screened for cardiovascular risk factors in our outpatient population and (2) to evaluate the benefit of introducing a shared care cardiovascular booklet. Methods  We assessed 80 patients who attend our service with RA. Our initial audit revealed that 80% of patients had not been thoroughly assessed for basic cardiovascular risk. Based on these findings, we created a shared care booklet. Results  On re-auditing our service, we found a significant improvement in the assessment of cardiovascular risks. Conclusion  There is currently a low level of screening for cardiovascular risks in busy outpatient clinics. We felt the introduction of a shared care booklet allowed an increased level of screening in our clinics and also acted as a tool for doctor and patient education.     

Transmission of infectious diseases in outpatient health care settings

Increased provision of health care in outpatient settings and concerns about occupational transmission of infections have focused attention on the risk of transmission of infectious diseases in ambulatory health care settings. In contrast to inpatient nosocomial infections, infections transmitted in outpatient settings are neither systematically monitored nor likely to be detected by routine qi surveillance. To better define the spectrum of such events, we reviewed the literature to identify cases and clusters of infections associated with outpatient health care. In this review, we identified and epidemiologically characterized 53 such reports that occurred from 1961 through 1990. Transmission occurred in general medical offices, clinics, and emergency departments (23); ophthalmologists' offices and clinics (11); dental offices (13); and alternative-care settings (six). Our findings suggest that inpatient infection-control practices should be extended to outpatient health care settings by assigning specific responsibility for infection control and by adapting surveillance methods and prevention measures.     

儿科住院医师规范化培训教学门诊的运行管理

教学门诊是为教学专门设立的门诊,学员作为主诊医生,进行病史采集、体格检查、诊断治疗等医疗活动,教师担任指导、协助的角色。在全国范围内,开展儿科住院医师规范化培训（以下简称“住培”）教学门诊的单位还不多。本文总结了浙江大学医学院附属儿童医院（“浙大儿院”）儿科住培教学门诊的运行管理经验。浙大儿院教学门诊以教学为核心任务,秉承人文关怀,以分层递进为原则,包括组织审批、前期安排、门诊预约及教学活动实施等运行环节。该门诊注重组织管理和质量管理,初步探索了教学门诊教学效果评价方案,并为儿科住培教学门诊未来发展提出了增加客观评价方法、增加儿科亚专科教学门诊等建议。     

Implementation of an on-line archive for retrieval of laboratory results for outpatients

An on-line archive of laboratory results designed specifically for ambulatory care areas is described. It is a direct result of paper-flow problems in clinics, which were manifested by numerous phone calls to the laboratory for test results performed up to 10 months ago, and requiring as much as 30 minutes each for retrieval. The archive is incorporated into the result inquiry program of our laboratory computer and is transparent to the user. Utilization of this system by our personnel saves up to 12 hours of work each day. By capturing in a separate file the patient location of each call for outpatient results we are able to identify the clinics that use the telephone for retrieval of test results.     

运用整合医学方法构建全科医学的问诊模型

全科门诊面对的大多是未分化疾病或亚健康问题,这类问题仅关注生理疾病无法做出令人满意的处理。本研究旨在从就诊原因（主要症状）入手,整合生活史和就诊目的等相关内容,构建一个适合全科医疗的问诊模型,丰富全人照顾的内涵,为选择有针对性的治疗方案,提高患者长期健康水平和满意度打下良好的基础。