摘要
病案管理工作是等级医院评审的重要考核内容,对病案业务的评审主要集中在制度建设、病历质量、人员配制、硬件配备以及业务能力5个方面。对此,医院进一步健全规章制度、完善病历内涵质量、疏理业务流程、理清人员配制、核对首页编码、合理统筹分工、硬件环境补缺,并且汇总了基本资料。针对评审中病案管理工作暴露的不足,建议应以评促改、以评促建并开展经常性的病案管理工作评价。
The quality of medical records management is an important part in Hospital Grade Judgment and Determination. The examination of medical records management focuses on the construction of rules, quality of medical records, positioning of person-nel, provision of equipment, and competence of the staff. Accordingly, we perfected the rules and regulations, optimized medical re-cords writing, streamlined management processes, rationalized division of responsibilities, checked the Icd-codes, replenished equip-ment, and coUected basic materials. Targeting the inadequates revealed in the examination, we offered suggestions that routine evalua-tion be regularly carried out on the quality of medical records management.
出处
《医学研究生学报》
CAS
北大核心
2014年第3期295-298,共4页
Journal of Medical Postgraduates
关键词
等级评审
军队医院
病案
管理
Hospital Grade Judgment and Determination
Military hospital
Medical records
Management
