基于三级公立医院绩效考核标准的手术患者并发症统计分析

黄俊杰; 黄明智; 朱敬蕊; 黄靖雯

doi:10.16766/j.cnki.issn.1674-4152.002613

基于三级公立医院绩效考核标准的手术患者并发症统计分析

doi: 10.16766/j.cnki.issn.1674-4152.002613

蚌埠医学院第一附属医院质量管理科，安徽蚌埠 233000

基金项目:

安徽省人文社会科学研究重点项目 SK2019A0208

详细信息

通讯作者:
黄靖雯, E-mail: 12211020053@fudan.edu.cn

中图分类号: R197.323.1 R619
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- 文章访问数: 594
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-15
- 网络出版日期: 2022-09-26

Statistics of surgical patients' complications based on performance appraisal of tertiary public hospitals

Department of Quality Management, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的手术患者并发症发生率是衡量医院医疗技术能力和管理水平的重要结果指标之一，手术患者并发症的统计和管理是医疗质量管理的重点和难点，参考我国三级公立医院绩效考核对手术患者并发症的统计方法，通过病案首页对某三级公立医院手术患者并发症进行统计和分析。方法在提高住院病案首页质量的基础上，参照我国三级公立医院绩效考核的统计方法，利用住院病案首页统计某三级公立医院2019—2020年的手术患者并发症情况，初步分析该院手术患者并发症情况，根据统计结果确定手术患者并发症高风险科室和重点病种。结果发生例数最多的手术患者并发症是出血或血肿、手术后切口愈合不良、肺部感染，3种并发症发生数占全院手术患者并发症总数的63.29%。并发症发生例数最多的临床科室在抗菌药物使用、术后护理等方面存在缺陷。结论手术患者并发症的管理情况复杂，不同并发症发生的原因多种多样，同一种并发症发生的原因也可能存在较大差异，精确的手术操作、精细化的护理、合理用药、仪器设备的正确使用都是预防手术患者并发症的重要手段。手术患者并发症的管理是诊疗行为全过程的管理，需要信息化的支持、配套制度的有效执行、多部门的协作，需要医院医疗技术水平作为保障。针对手术患者并发症的各项干预措施也应进行评价并不断优化。
- 三级公立医院 /
- 绩效考核 /
- 手术患者并发症
Abstract: Objective The complication rate of surgical patients is one of the important outcome indicators to measure the medical technical ability and management level of hospitals. The statistics and management of surgical complications are the key and difficult points of medical quality management. Referring to the statistical methods of surgical complications in the performance appraisal of three-level public hospitals in China, the complications of surgical patients are counted through the medical record homepage. Methods On the basis of improving the quality of the medical record homepage, the complications of surgical patients in a three-level public hospital from 2019 to 2020 were counted using the first page of inpatient medical records. The complications of surgical patients in the hospital were preliminarily analysed and the high-risk departments and key diseases of surgical patients were determined in accordance with the statistical results. Results The complications of surgical patients with the largest number of cases were bleeding or hematoma, poor wound healing and pulmonary infection. The number of three complications accounted for 63.29% of the total number of surgical complications in the hospital. The clinical department with the largest number of complications had defects in the use of antibiotics and postoperative nursing. Conclusion The management of complications in surgical patients is complex. The causes of different complications are diverse and great differences may exist in the causes of the same complication. Accurate surgical operation, fine nursing, rational drug use and correct use of instruments and equipment are important means to prevent complications in surgical patients. The management of surgical patients' complications is the management of the whole process of diagnosis and treatment behaviour. It needs the support of informatisation, the effective implementation of supporting systems, the cooperation of multiple departments and the level of hospital medical technology as a guarantee. The intervention measures for the complications of surgical patients should also be evaluated and continuously optimised.
- Tertiary public hospitals /
- Performance appraisal /
- Complications of surgical patients

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表 1 全院2019—2020年入院病情诊断为“无”统计

Table 1. The diagnosis of hospital admission from 2019 to 2020 was "no" statistics

年份	入院病情为“无”的诊断数量(例)	入院病情为“无”的诊断涉及病历数量(例)	入院病情错填为“无”的病历数量(例)	入院病情项目填写正确率(%)
2019	2 113	1 409	75	94.68
2020	1 988	1 187	51	95.70

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表 2 2019—2020年手术患者并发症统计表

Table 2. Statistical table of surgical complications from 2019 to 2020

序号	手术患者并发症种类	2019年(例)	2020年(例)	合计(例)	占比(%)
1	出血或血肿	38	23	61	23.83
2	手术后切口愈合不良	23	34	57	22.27
3	肺部感染	21	23	44	17.18
4	生理/代谢紊乱	9	19	28	10.94
5	瘘	18	5	23	8.98
6	呼吸衰竭	8	7	15	5.86
7	深静脉血栓	7	5	12	4.69
8	术中发生或手术造成的休克	5	4	9	3.52
9	骨折	3	0	3	1.17
10	肺栓塞	2	0	2	0.78
11	败血症	0	1	1	0.39
12	手术后血管并发症	1	0	1	0.39
13	猝死	0	0	0	0
14	人工气道意外脱出	0	0	0	0
合计		135	121	256	100.00

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表 3 2019—2020年手术患者并发症前10位科室表

Table 3. Table of top 10 departments of surgical patients with complications from 2019 to 2020

序号	科室	手术患者并发症(例)
1	肿瘤妇科	31
2	胃肠外科	27
3	神经外科	25
4	肿瘤外科	25
5	妇科	22
6	产科	20
7	心脏外科	16
8	胸外科	15
9	骨科	14
10	急诊外科	12

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表 4 2019—2020年手术患者并发症发生率前10位科室表

Table 4. Top 10 departments in the incidence of surgical complications from 2019 to 2020

序号	科室	手术患者并发症例数	手术患者例数	手术患者并发症发生率(%)
1	神经外科	25	2 658	0.94
2	胃肠外科	27	3 350	0.81
3	心脏外科	16	2 204	0.73
4	妇科	22	3 088	0.71
5	产科	20	3 504	0.57
6	胸外科	15	3 170	0.47
7	肿瘤妇科	31	7 237	0.43
8	急诊外科	12	2 994	0.40
9	泌尿外科	11	3 910	0.28
10	血管外科	8	3 530	0.23

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