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目的通过分析某三级甲等医院手术科室运行和质量统计数据,提出科室管理和服务中存在的问题和建议,为改善医院管理和服务流程提供依据。方法从医院质量监测系统(HQMs)、病案统计管理系统和感染管理信息系统中搜集2012年-2015年医院运行和病案首页资料,利用Excel的表格统计和柱状图、折线图等图表功能对手术科室各项指标进行数据处理,分析其意义。结果 14个手术科室的12项监测指标中,四个科室平均住院日高于12天、12个科室床位使用率超出85~93%的范围、七个科室三四级手术率低于50.24%、医院手术患者围手术期死亡率高于0.1%、两个科室手术患者感染率高于1.5%、年手术及操作占出院人次比例中单纯外科手术量低于35%,年外科手术人次占外科出院人次比例低于65%,不符合国家卫生计生委医疗质量指标值及全国统计基准值要求。结论应降低平均住院日,合理控制床位使用率,提高三四级手术率,降低手术患者死亡率和感染率,提高工作负荷能力,保证患者手术质量和安全,提升医院手术管理水平。
Objective To analyze the operation and quality statistics of surgical departments in a third class Hospitals, and to put forward some problems and suggestions in department management and services so as to provide evidences for improving hospital management and service processes. Methods The data of hospital operation and medical records from 2012 to 2015 were collected from the hospital quality monitoring system (HQMs), medical records management system and infection management information system. The data of the charts and charts of Excel and histogram and line charts were used to analyze the surgical departments The indicators for data processing, analysis of its significance. Results Of the 12 monitoring indicators in 14 surgical departments, the average length of stay in four departments was higher than 12 days, the bed occupancy rate in 12 departments exceeded the range of 85-93%, the operation rates in 34 or more levels in seven departments were lower than 50.24% Perioperative mortality was higher than 0.1% in hospital surgery patients, the infection rate was higher than 1.5% in two departments, the annual surgical operation and operation accounted for less than 35% of the total number of patients were discharged, the annual surgical operation accounted for surgical discharge People less than 65% of the proportion, does not meet the National Health and Family Planning Commission medical quality indicators and the national statistical benchmark value requirements. Conclusion The average length of stay should be reduced, the bed occupancy rate should be controlled reasonably, the operation rate of three or four stages should be increased, the mortality and infection rate of operation patients reduced, the workload capacity should be improved, the operation quality and safety should be guaranteed, and the operation management level should be improved.