三甲医院超长住院日患者分布特征与改进措施研究

目的对三甲医院超长住院日患者的分布特征进行描述,并探讨缩短住院天数的措施,以提高医院社会效益和经济效益。方法通过病案数据库和病案统计软件导出2018年1月1日-12月31日的全部出院患者的首页信息,定义住院天数大于30天为超长住院日,对数据进行统计分析。结果 2018年全年出院患者215 459例,其中超长住院日患者4 810例,占2.2%。超长住院日患者占用总床日数占全部总出院患者占用总床日数的10.5%,总费用占全部患者总费用的10.8%。超长住院日患者的男女构成、年龄分布、医疗付款方式分布与住院30天以内的患者均有差异(P<0.05)。超长住院日患者数量前5名的科室为放射治疗科、血液内科、康复科、神经外科和肿瘤内科,前5名的疾病大类为恶性肿瘤、影响健康状态的因素、循环系统疾病、损伤、中毒及外因和良性肿瘤。手术科室出院的超长住院日患者中有270例未做手术,占总数的16.89%,其中疼痛科与神经外科较多。结论应建立预警机制、加强病种监督、医联体建设、提高医技工作效率、推行日间手术、完善绩效考核机制,以缩短住院天数。

Distribution characteristics of patients with over-longhospitalization in a Grade 3 and first-class hospitaland study on improvement measures

Objective To describe the distribution characteristics of patients with over-long hospitalization in a Grade 3 and first-class hospital and to explore the improvement measures. Methods The information of all the medical records in a hospital in 2018 was obtained and analyzed through medical record database and CMIS. The definition of over-long hospitalization day was more than 30 hospitalization days. Results In 2018, 215 459 patients was discharged from the hospital, and among them, 4 810 patients (2.2%) had over-long hospitalization days. The percentage of total bed-times of the patients with over-long hospitalization days among the total bed-times of the discharged patients was 10.5%, and the hospitalization expenses of patients with over-long hospitalization days accounted for 10.8% of the total cost of all patients. There were significant difference between the patients with over-long hospitalization days and the patients withoutover-long hospitalization days (less than 30 days) in the sex distribution, age distribution and medical payment distribution (all P<0.05). The top five departments of the patients with over-long hospitalization days were the radiation therapy department, hematology department, recovery department, neurosurgery department, and department of oncology. The top five disease categories were malignant tumor, factors affecting health status, circulatory system diseases, damage, and poisoning and benign tumor. In the surgery departments, 270 patients with over-long hospitalization days did not have surgery, which accounted for 16.89%, and among them, the cases of the pain department and neurosurgery were more than that of the other departments. Conclusion We should establish the early warning mechanism, strengthen the disease surveillance, build the medical association, improve the efficiency of the technical departments, implement the day surgery, and improve the performance appraisal mechanism, so as to shorten the hospitalization days.