三级医院联合社区卫生服务机构开展延续护理的SWOT分析

SWOT analysis of transitional care for third-level hospitals and community health service institutions

目的探讨三级医院联合社区卫生服务机构开展延续护理的优势、劣势、机遇和挑战,为延续护理的可持续发展以及双向转诊、分级诊疗工作的推进提供思路和借鉴。方法采用SWOT分析法,从理论层面深入分析三级医院联合社区卫生服务机构开展延续护理的可行性和所面临的主要困境,同时结合宜昌市某三甲医院2012年5月以来的实践经验做进一步阐述。结果基于分病种三级医院联合社区卫生服务机构开展延续护理能够有效整合现有卫生资源,尤其是在三级医院床位紧张而社区卫生机构利用率不足的情况下,能够最大限度地发挥现有卫生资源优势,促进患者合理分流,提高三级医院的床位周转率,提升社区卫生服务机构医务人员的专业技术水平和群众对社区卫生服务机构的信任度,有利于分级诊疗工作的进一步推进。但是,社会对延续护理认识不足,双向转诊机制、延续护理体系不完善,社区专科护理发展不足,下转患者无力承接却是制约延续护理的关键。结论在各级政府的重视和政策、资源的支持下,充分发挥本地医疗资源优势,克服劣势,利用外部机会,化解各种挑战,采用三级医院联合社区卫生服务机构开展延续护理,可以确保延续护理得到可持续发展,并为双向转诊和分级诊疗工作的推进奠定基础。

Objective To explore the advantages,disadvantages,opportunities and challenges of the third-level hospitals and community health service institutions on carrying out transitional care,to provide ideas and references for the sustainable development of transitional care and the promotion of the two-way referral and grading treatment. Methods Using SWOT analysis method,we made from the theoretical perspective an in-depth analysis of the feasibility and dilemmas in the transitional care between the third-level hospital; community health service organization. And we made a further illustration based on the practical experience of a first-class hospital at Grade 3 in Yichang since May,2012. Results Transitional care can effectively integrate and use the existing health resources under the conditions that the third-level hospitals lacking sickbeds while the community health services sparing lots of sickbeds. It can promote the rational distribution of patients and improve the sickbed turnover of third-level hospitals,improve the level of medical personnel of the community health service institutions and the degree of trust of patients on the community health service institutions,and promote the implementation of grading treatment. However,the social awareness of the transitional care is still inadequate,two-way referral mechanism and transitional care system is not still perfect,community nursing is still with weak abilities and unable to undertake all the referral patients from the third-level hospitals,all these factors are the key to restrict transitional care.Conclusion Under the attention and support of the government,we can fully use the local medical resources,overcome the disadvantages,utilize the external opportunities and resolve various challenges,carry out the transitional care between third-level hospitals and community health service institutions,ensure the sustainable development of nursing,and lay the foundation for the promotion of two-way referral and grading treatment work.