摘要
目的探索建立科学的全面质量管理体系,以应对医院评审工作常态化的新要求。方法成立全面质量管理办公室,组建质管员队伍,构建以委员会为抓手的“大质控”体系,并从月度质控与不良事件正反两个方向查找质量管理问题,持续提升医疗质量。结果医院临床路径覆盖率、病案首页主要诊断编码正确率、静脉血栓栓塞症规范预防率、手术患者并发症发生率等各项关键指标有了明显改善,质量改进案例屡获大奖,医院三级公立医院绩效考核排名由B++上升至A序列。结论层级明晰、运行高效的“大质控”体系能够有效应对医院评审新要求,从而促进医院高质量发展。
Objective To explore the establishment of a scientific comprehensive quality management system in response to the new requirements for the normalization of hospital accreditation.Methods A comprehensive quality management office was established,and a team of quality control personnel was assembled.Besides,a"Big Quality Control"system with committees as the core was constructed.Quality management issues were identified from both positive and negative aspects through monthly quality control assessments and adverse event reviews,thus continuously improving medical quality.Results Significant improvements were observed in various key indicators,including the hospital's coverage rate of clinical pathway,accuracy of coding the main diagnoses on the front page of medical records,standardized prevention rate of venous thromboembolism,and the incidence of complications in surgical patients.Quality improvement cases have repeatedly won awards,and the hospital's ranking in the performance evaluation of tertiary public hospitals has risen from B++to the A sequence.Conclusion A clearly structured and efficiently operated"Big Quality Control"system can effectively address the new requirements of hospital accreditation and promote high-quality development of hospitals.
作者
丰成祥
王晓敏
李静
马西文
Feng Chengxiang;Wang Xiaomin;Li Jing;Ma Xiwen(Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan Province,China)
出处
《中国医疗管理科学》
2025年第2期50-55,共6页
Chinese Journal Of Medical Management Sciences
基金
郑州市2022年度社会科学调研课题项目(ZSLX2022+0203)。
关键词
全面质量管理体系
医院评审
医疗质量
Comprehensive quality management system
Hospital accreditation
Medical quality
