基于多因素评价法的医院职能部门绩效评价

为调动职能部门的积极性和主动性,进行职能部门绩效评价,以提高医院管理效能。方法采用多因素评价法进行绩效评价,德尔菲法建立评价指标体系,模糊综合评判法确定权重系数,SPSS 23.0统计软件进行数据统计分析。结果经过7年连续考评,评价结果呈近似标准正态分布,具有一定的科学性和公平性。不同类别评委对职能部门绩效评价基本一致;不同组别部门绩效评价差距较大;职能部门效能整体提升,部门间差距缩小。结论基于多因素评价法的绩效评价能有效促进职能部门工作改进。针对存在不足,建议不断优化评价指标,搭建“组织部门-评价对象-评价者”的多向沟通平台,以实现绩效考核体系信息化     

大型综合医院门诊应对新型冠状病毒肺炎疫情的管理策略

目的为了有效做好新型冠状病毒肺炎疫情的防控工作,减少人员聚集、切断传播途径,防止交叉感染,在门诊正常医疗工作开展的同时保障医疗环境安全。方法优化门诊空间布局,调整和管控患者进出路线;合理调配人力资源,控制出诊医生人数及号源总量,管控人流量;借助信息系统平台进行患者流行病学及相关症状筛查,建立严格、规范的三级预检分诊体系;加强各岗位医务人员相关防护知识的培训。结果 2020年1月28日—2月6日,该院门诊共筛查出高危患者82例,全部护送至发热门诊作筛查,其中确诊新型冠状病毒感染阳性1例,疑似病例1例。结论在新型冠状病毒肺炎疫情发生的情况下,采取全院多部门联动,建立规范的三级预检分诊体系,能有效早发现、早报告、早隔离、早治疗疑似病例,从而保证门诊医疗环境的安全。     

Prognosis for older people at presentation to emergency department based on frailty and aggregated vital signs

Background

Risk stratification for older people based on aggregated vital signs lack the accuracy to predict mortality at presentation to the Emergency Department (ED). We aimed to develop and internally validate the Frailty adjusted Prognosis in ED tool (FaP-ED) for 30-day mortality combining frailty and aggregated vital signs.

Methods

Single-center prospective cohort of undifferentiated ED patients aged 65 or older, consecutively sampled upon ED presentation from a tertiary Emergency Center. Vital signs were aggregated using the National Early Warning Score (NEWS) as a measure of illness or injury severity and frailty was assessed with the Clinical Frailty Scale (CFS). The FaP-ED was constructed by combining NEWS and CFS in multivariable logistic regression. The primary outcome was 30-day mortality. Measures of discrimination and calibration were assessed to evaluate predictive performance and internally validated using bootstrapping.

Results

2250 patients were included, 67 (1.8%) were omitted from analyses due to missing CFS, loss to follow-up, or terminal illness. Thirty-day mortality rate was 5.4% (N = 122, 95% CI = 4.5%–6.4%). Median NEWS was 1 (Inter-Quartile Range (IQR): 0–3) and median CFS was 4 (IQR: 3–5). The Area Under Receiver Operating Characteristic (AUROC) for FaP-ED was 0.86 (95% CI = 0.83–0.90). This was significantly higher than NEWS (0.81, 95% CI = 0.77–0.85, DeLong: Z = 3.5, p < 0.001) or CFS alone (0.82, 95% CI = 0.78–0.86, DeLong: Z = 4.4, p < 0.001). Bootstrapped estimates of FaP-ED AUROC, calibration slope, and intercept were 0.86, 0.95, and −0.09, respectively, suggesting internal validity. A decision-threshold of CFS 5 and NEWS 3 was proposed based on qualitative comparison of positive Likelihood Ratio at all relevant FaP-ED cutoffs.

Conclusion

Combining aggregated vital signs and frailty accurately predicted 30-day mortality at ED presentation and illustrated an important clinical interaction between frailty and illness severity. Pending external validation, the Fap-ED operationalizes the concept of such “geriatric urgency” for the ED setting.     

Developing a Comprehensive Resident-driven Research Training Pathway: A Chief Resident's Perspective

Wide variation exists in research training, experience, opportunities, and exposure across various radiology residency training programs, ranging from having a dedicated research track to no exposure to hypothesis driven projects. Studies conducted at different residency training programs with varied resources and National Institutes of Health funding have shown that resident-driven research initiatives and mentorship programs have the potential to improve research experience during residency training, engage more medical students in research, increase departmental peer-reviewed publications and increase peer-reviewed publications of early-career faculty physicians. In an attempt to standardize the research training during radiology residency, we propose a standardized resident-led program which institutions may adapt, as well as resources that the American Alliance of Academic Chief Residents in Radiology (A³CR²) might compile in collaboration with other national organizations to improve trainee's research experience during their radiology residency training.