医疗失效模式和效果分析在重症监护病房运行管理中的应用
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摘要
目的优化医院重症监护病房运行管理,提高其运行效率与质量。方法运用医疗失效模式与效应分析(HFMEA)对重症监护病房的运行管理进行分析,了解运行失效发生的过程及原因,并制定相应的改进措施。结果改进方案实施后,重症监护病房床位使用率适度降低(t=13.05,P<0.01),从87.84%降至73.70%,维持在更加合理的水平;患者在ICU的治疗时长的中位数从4 d降至3 d(S=65152.5,P<0.01);应急床天数构成比从65.75%提高至98.36%,差异有统计学意义(χ~2=357.55,P<0.01)。结论应用HFMEA可以有效优化重症监护病房的运行效率与质量。
Objective To optimize the operation and management of hospital intensive care unit and improve its operational efficiency and quality. Methods Medical failure mode and effect analysis(HFMEA) was used to analyze the operation and management of intensive care unit, to understand the process and causes of operational failure, and to develop corresponding improvement measures. Results After the implementation of the improvement program, the bed occupancy rate of the intensive care unit was moderately reduced(t=13.05, P<0.01), from 87.84% to 73.70%, which was maintained at a more reasonable level. The median duration of treatment in the ICU fell from 4 days to 3 days(S=65152.5, P<0.01). The number of emergency bed days increased from 65.75% to 98.36%, and the difference was statistically significant(χ~2=357.55, P<0.01). Conclusion The application of HFMEA can effectively optimize the operational efficiency and quality of the intensive care unit.
Objective To optimize the operation and management of hospital intensive care unit and improve its operational efficiency and quality. Methods Medical failure mode and effect analysis(HFMEA) was used to analyze the operation and management of intensive care unit, to understand the process and causes of operational failure, and to develop corresponding improvement measures. Results After the implementation of the improvement program, the bed occupancy rate of the intensive care unit was moderately reduced(t=13.05, P<0.01), from 87.84% to 73.70%, which was maintained at a more reasonable level. The median duration of treatment in the ICU fell from 4 days to 3 days(S=65152.5, P<0.01). The number of emergency bed days increased from 65.75% to 98.36%, and the difference was statistically significant(χ~2=357.55, P<0.01). Conclusion The application of HFMEA can effectively optimize the operational efficiency and quality of the intensive care unit.
引文
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[3] Dehnavieh R,Ebrahimipour H,Molavi-Taleghani Y,et al.Proactive risk assessment of blood transfusion process,in pediatric emergency,using the Health Care Failure Mode and Effects Analysis(HFMEA)[J].Glob J Health Sci,2014,7(1):322-331.
[4] Rah JE,Manger RP,Yock AD,et al.A comparison of two prospective risk analysis methods:Traditional FMEA and a modified healthcare FMEA[J].Med Phys,2016,43(12):6347.
[5] Marquet K,Claes N,Postelmans T,et al.ENT one day surgery:Critical analysis with the HFMEA method[J].BENT,2013,9(3):193-200.
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[7]许苹,许敏,刑茂迎,等.FMEA在医疗风险管理中的应用以及局限性[J].现代预防医学,2007,34(1):51-52.
[8]李洋,杜蕾,张立超,等.FMEA法在医疗风险管理中的应用现状与展望[J].中国医院管理,2014,34(9):36-37.
[9]张立,安利群,沙鸣芳,等.医疗失效模式与效应分析在降低外科医护人员HIV职业暴露中的应用效果[J].中华现代护理杂志,2015,21(2):208-210.
[10]潘黎,潘小炎,陈武朝.我国医疗失效模式与效应分析的应用现状及问题[J].医学与哲学(B),2014,35(6):89-93.
[11]刘嘉吉,马尚寅,王海燕,等.公立医院改革新形势下大型综合医院质量管理体系所面临的挑战[J].医学理论与实践,2016,29(21):3016-3017.
[12]章治庆,曾磊,周丽娟,等.医疗失效模式与效应分析在预防老年患者院内压疮中的应用[J].宁夏医学杂志,2017,39(6):527-529.
[13]阳佩,童宇平,张欢.HFMEA在急诊病人院内转运输液管理中的应用[J].护理研究,2018,32(8):1262-1267.
[14]郭琳.加强职能部门的执行力保障医院可持续发展[J].江苏卫生事业管理,2011,22(1):41-42.
[15]秦敬柱,温成泉,王国安,等.医院职能部门协同管理效果分析[J].中国卫生质量管理,2014,21(2):102-104.
[2] DeRosier J,Stalhandske E,Bagian JP,et al.Using health care failure mode and effect analysis:the VA National Center for Patient Safety's prospective risk analysis system[J].Jt Comm J Qual Improv,2002,28(5):248-267,209.
[3] Dehnavieh R,Ebrahimipour H,Molavi-Taleghani Y,et al.Proactive risk assessment of blood transfusion process,in pediatric emergency,using the Health Care Failure Mode and Effects Analysis(HFMEA)[J].Glob J Health Sci,2014,7(1):322-331.
[4] Rah JE,Manger RP,Yock AD,et al.A comparison of two prospective risk analysis methods:Traditional FMEA and a modified healthcare FMEA[J].Med Phys,2016,43(12):6347.
[5] Marquet K,Claes N,Postelmans T,et al.ENT one day surgery:Critical analysis with the HFMEA method[J].BENT,2013,9(3):193-200.
[6]曹晖,任红.医疗失效模式在神经外科重症患者院内转运中的应用[J].当代护士(上旬刊),2017,(8):35-36.
[7]许苹,许敏,刑茂迎,等.FMEA在医疗风险管理中的应用以及局限性[J].现代预防医学,2007,34(1):51-52.
[8]李洋,杜蕾,张立超,等.FMEA法在医疗风险管理中的应用现状与展望[J].中国医院管理,2014,34(9):36-37.
[9]张立,安利群,沙鸣芳,等.医疗失效模式与效应分析在降低外科医护人员HIV职业暴露中的应用效果[J].中华现代护理杂志,2015,21(2):208-210.
[10]潘黎,潘小炎,陈武朝.我国医疗失效模式与效应分析的应用现状及问题[J].医学与哲学(B),2014,35(6):89-93.
[11]刘嘉吉,马尚寅,王海燕,等.公立医院改革新形势下大型综合医院质量管理体系所面临的挑战[J].医学理论与实践,2016,29(21):3016-3017.
[12]章治庆,曾磊,周丽娟,等.医疗失效模式与效应分析在预防老年患者院内压疮中的应用[J].宁夏医学杂志,2017,39(6):527-529.
[13]阳佩,童宇平,张欢.HFMEA在急诊病人院内转运输液管理中的应用[J].护理研究,2018,32(8):1262-1267.
[14]郭琳.加强职能部门的执行力保障医院可持续发展[J].江苏卫生事业管理,2011,22(1):41-42.
[15]秦敬柱,温成泉,王国安,等.医院职能部门协同管理效果分析[J].中国卫生质量管理,2014,21(2):102-104.