学习型组织文化在优质护理服务中的应用

目的探讨应用学习型组织文化进行护理管理,提高医院创建优质护理服务的效果。方法从更新观念、层级管理、调研基层、加强培训、激励机制等5个方面构建学习型组织文化,并应用于本院护理管理中。采用分层抽样的方法,抽取300名护士,应用自行设计的护士满意度问卷进行实施前后调查;实施前后抽取每名护士所负责患者3例,共1 800例患者,应用自行设计的患者满意度问卷进行调查。结果干预前后护士满意度总分及其在管理、工作负荷、与同事关系、个人成长与发展、工作被认可5个维度得分比较,差异有统计学意义(均P<0.01);干预前后患者满意度在创优知晓、主动服务、基础护理、出院体验、护理管理、红灯呼叫、陪护等方面得分比较,差异有统计学意义(P<0.01,P<0.05)。结论构建学习型组织文化能提高医院创建优质护理服务的效果,是一种有效的护理管理手段。     

The organisation of an ophthalmological service for diabetics in a teaching hospital

A new system of ophthalmological evaluation of diabetic patients in a teaching hospital has been devised. All the patients attending the diabetic clinic were screened by ophthalmologists. Any patient with a problem was then referred to a diabetic ophthalmology clinic where a full evaluation was done and treatment given where necessary. In an 18-month period 1,015 new ophthalmological diabetic patients were screened. Of these patients 13.6% had background retinopathy, 8.4% pre-proliferative retinopathy and 3.4% proliferative retinopathy, while 8.6% had maculopathy. These results show that even in a teaching hospital a significant percentage of patients already have pre-proliferative or even proliferative retinopathy when seen by an ophthalmologist for the first time. The importance of organising an ophthalmological service for the diabetic patient is stressed.     

Value of radiograph audit in an accident service department.

In our accident service department all trauma radiographs are reported acutely and those misinterpreted by the casualty officers are presented at the daily clinicoradiological conference. We have reviewed this practice over a 6-month period. From over 25,000 patients attending the accident service, 16,246 radiographs were requested and reported. Of these, 456 (2.8 per cent) were considered to have been potentially misinterpreted. The errors included 167 (1 per cent) missed fractures, 55 (0.3 per cent) suspected fractures and 72 (0.4 per cent) false-positive diagnoses of fracture. Subsequently, 114 (0.7 per cent) patients required recall for treatment or further imaging. Incorrect diagnoses were seen most frequently in the more commonly injured anatomical sites--the ankle, wrist, foot, elbow and hand. However, the incidence of misinterpretation was highest in examination of the fingers, especially in children. We believe that these low figures are principally the result of involving both orthopaedic surgeons and radiologists at the formal daily conference. We regard our system of audit as beneficial to patients' care and anticipate reduced litigation which may offset the increased cost of audit.     

G. I. diagnostics; its ranking and interdisciplinary organisation (author's transl)

The complicated and expensive diagnostic apparatus available today has to be applied in an orderly sequence. This order depends on certain prerequisites, e.g. on the disease, urgent complications, patient tolerance, apparatus potential, hospital structure and organisation etc. The more rational the indication is to use certain methods, the more efficient will be the results. The appropriate concepts and suggestions for certain general and specific examples, used by us at present are demonstrated. Complicated and expensive diagnostic procedures have to be decided primarily on an interdisciplinary level. The increased costs of these procedure are balanced by a decrease in hospital stay and fewer operative explorations too. At other places different actions will be taken for equally good reasons.     

An informatics service for the endoscopy service]

The authors describe an original program, created by the collaboration between endoscopists and computer science agent. They illustrate the main features of the program, called "Endo", and its application.     

More effective surgical care and its regional organisation (author's transl)

The decrease of the number of surgical cases within the past few years was not essentially due to the decrease of the number of hospital surgeons or to the decrease of the number of beds in surgical units. Decrease in the length of stay and increase in bed occupancy rate might effectively respond to increasing demands. A community comprising about 60 000 inhabitants will occupy a fulltime outpatient surgeon. Smaller communities should be served by an integrate inpatient-outpatient service. There is no need for each surgical unit to run a separate emergency service of its own.