论文部分内容阅读
目的分析医院住院病案复印情况,以加强病案质量管理。方法统计近5年病案资料复印17,200人次。结果住院病案资料复印数量逐年增加,主要用于医保报销及商业保险占61.94%、院外治疗占18.38%、医学证明及其他占19.67%。结论病案复印服务需求不断增加,提示应严格执行规范的工作流程,及时做好病案归档工作,提高病案书写质量,认真总结工作经验。加强病案管理人员的法律意识和服务意识,树立良好形象,加强与患者的沟通,为患者提供方便,才是做好病历复印工作的关键。
Objective To analyze the inpatient medical record copy in hospital so as to strengthen the medical record quality management. Methods Statistics 17,500 copies of medical records in the recent 5 years. Results The number of copies of inpatient medical records increased year by year, mainly for health insurance reimbursement and commercial insurance accounted for 61.94%, 18.38% of hospital treatment, medical certificates and others accounted for 19.67%. Conclusion The demand for medical record-copying service is increasing, suggesting that the standard workflow should be strictly followed, the medical record filing work should be done in a timely manner, the quality of medical record writing should be improved, and the work experience should be conscientiously summed up. Strengthening the legal awareness and service awareness of case management personnel, establishing a good image, strengthening communication with patients, and providing convenience to patients are the keys to doing a good job in photocopying medical records.