中型综合性医院婴幼儿心脏手术的持续质量改进简

目的 研究中型综合性医院婴幼儿体外循环（CPB）心脏手术的质量管理和持续质量改进方法.方法 将婴幼儿先天性心脏病（CHD）CPB心内直视手术251例,分为对照组108例,改进组143例.分别对比住院病死率、主要并发症发生率、CPB时间、呼吸机辅助时间、住ICU时间、住院时间、住院总费用、家长满意度、投诉事件数量及纠纷产生的医院补偿费用等.结果 251例患儿总住院病死率为4.4%.对照组病死率6.4%高于改进组的2.8%,差异有统计学意义.改进组主要并发症发生率、呼吸机辅助时间、住ICU时间、住院时间、投诉事件数量及纠纷产生的医院补偿费用等均明显减少,家长满意度明显增加,差异有统计学意义.结论 中型综合性医院可以开展高质量的婴幼儿心脏手术,但要注重质量控制,不断提高婴幼儿CHD手术的整体疗效.

Continuous quality improvement for the cardiac surgery of infants in medium-sized hospital

Objective To evaluate quality management and methods of continuous quality improvement for the cardiac surgery of infants under cardiopulmonary bypass （ CPB ） in medium-sized hospital. Methods Summarize retrospectively 251 cases of open heart surgery for congenital heart disease （CHD） within less than 3 years old under CPB since 2002,108 cases before December 2008 as the control group （group C） and 143 cases after January 2009 as the quality improvement group （group Q ）. Compare respectively hospital mortality, incidence of major complications, CPB time, mechanical ventilation time, ICU admission time, hospitalization time, to- tal hospitalization cost, parents satisfaction. Results 11 patients died of postoperation, and the total hospital mortality was 4.4%. Mortality in group C was 6.4%, while in group Q was 2.8%. The two groups had significant differences. CPB time, total hospitalization cost had no significant difference, but the incidence of major complications, mechanical ventilation time, ICU admission time, hospitalization time,the number of complaints, hospital compensation cost resulting from disputes etc,decreased dramatically （had significant differences）, and parent satisfaction increased obviously （had significant differences）. Conclusion Continuous quality improvement should become an important part of managers＇daily work. Correctly grasp three basic steps of quality control in the cardiac surgical field, namely insight into the problem and find possible factors causing the problem and correct errors seriously. Only in this way we will make over-all treatments for the cardiac surgery of infants with CHD increase constantly.