完善牡丹江地区医院病人投诉处理机制研究

科学高效的病人投诉处理机制有利于管理者及时发现医院管理中存在的问题,进而提高医疗服务质量、更好地保障医疗服务安全。以牡丹江地区5所医院为样本,收集到926件病人投诉案例,通过调查研究和统计数据的分析,发现本地区医院在病人投诉处理工作中存在的问题。应研究并采用PDCA循环管理模式,建立和完善医院病人投诉处理机制。     

试议医疗投诉的关系营销

1医疗投诉的内容、原因和影响 1.1医疗投诉的内容 医疗投诉是就医顾客及其家属在接受医疗保健服务的过程中,对医院或医务人员提供的服务不满意并向有关部门反映问题的一种行为。北京大学医学部方爱珍和张拓红对某市3所综合医院2002年1283件医疗投诉的研究表明,医疗投诉的内容主要有以下几类：     

有效处理病员抱怨提升医疗服务品质

激烈的医疗市场竞争,日益增加的病人需求,使病人对医疗服务的不满意日渐上升;同时也给进行中的医疗行为带来了各种影响与损害。如何改善医患关系,提高病人的满意度,减少病人的抱怨与投诉,是每一个管理者思考的必然课题。笔者就所在的医院2004年病人满意度回顾分析如下。     

38例医保患者医疗投诉分析

医疗投诉是指患者及家属在医院接受医疗保健服务的过程中,对医院或医院工作人员所提供的服务不满意而到有关部门反映问题的一种行为[1].城镇职工基本医疗保险制度在全国范围建立,作为国家卫生体制改革的一项重要举措,势必对医院产生影响.我院作为省市医疗保险定点的转诊医院,2005年医疗保险患者转诊达948例.随着人们对健康服务的要求越来越高,医保患者的医疗投诉事件也越来越多.为了减少投诉发生率及更好地处理投诉事件,我们对一年的医保患者医疗投诉发生的原因及规律进行了调查,分析如下:     

门诊就诊病人的投诉原因及对策

门诊是医院对外的重要服务窗口,也是病人就诊的主要场所,担负着繁重的医疗任务,因其服务对象复杂,病人就诊相对集中,医务人员素质参差不齐,就诊手续繁琐等特点.近年来,随着人们生活水平提高,对法律意识的不断增强,而医院门诊的服务,医疗技术和管理水平等均难以满足病人的要求,故病人的投诉常有发生,本院2003年11月至2005年6月共发生31例门诊投诉,下面就其发生的原因及相应的防范对策加以分析.     

门诊就诊病人的投诉原因及对策

门诊是医院对外的重要服务窗口，也是病人就诊的主要场所，担负着繁重的医疗任务，因其服务对象复杂，病人就诊相对集中，医务人员素质参差不齐，就诊手续繁琐等特点。近年来，随着人们生活水平提高，对法律意识的不断增强，而医院门诊的服务，医疗技术和管理水平等均难以满足病人的要求，故病人的投诉常有发生，本院2003年11月至2005年6月共发生31例门诊投诉，下面就其发生的原因及相应的防范对策加以分析。     

门诊投诉原因分析与处理策略

目的：分析门诊投诉的原因和分布特征,提高门诊服务质量。方法：2006年1月～2008年6月门诊病人文字记录的投诉共计392份。对数据进行统计处理并回顾性分析。结果：392例投诉中,服务态度投诉所占比例最高;其次是丁作马虎、不认真;对医疗行业的不理解;医院内部流程或协调缺陷的投诉,经过优化就诊流程,投诉明显下降。结论：医院应转变服务观念、增强服务意识、改善服务态度,提供优质服务。同时应加强门诊管理,优化医院内部流程;门诊医疗投诉应引起医院管理部门的重视,积极妥善处理。     

医院投诉档案管理工作浅议

医院投诉档案主要是指患者及其家属等有关人员对医院提供的医疗、护理服务及环境设施等不满意,向医院反映问题,提出意见和要求后形成的文字材料。加强医院投诉档案管理,规范投诉处理程序,是维护正常医疗秩序,保护医患双方合法权益,促进医患关系和谐的重要举措。     

医疗服务投诉现状分析及处理

通过对医院医疗服务投诉产生的原因、类型等分析,结合实际工作经验总结各类医疗服务投诉的处理步骤及方法,并提出改善医疗服务质量,降低医疗服务投诉的途径,旨在一定程度上缓解医患关系紧张的局面,构建和谐医疗氛围。     

医疗服务投诉现状分析及处理

通过对医院医疗服务投诉产生的原因、类型等分析,结合实际工作经验总结各类医疗服务投诉的处理步骤及方法,并提出改善医疗服务质量,降低医疗服务投诉的途径,旨在一定程度上缓解医患关系紧张的局面,构建和谐医疗氛围。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.