某院病案科室建设中的问题与改进措施

Problems Existing in the Construction of Medical Record Department in a Hospital and Relevant Improvement Measures

某院的病案管理在医院评审中暴露出诸多问题,如科室管理薄弱,人员知识结构以及工作职能等方面存在不足,影响了科室建设,对医院的电子病历及信息化建设带来不利影响。在医院评审前,自查医院实际工作中存在的问题,进行相应的整改。通过加强科室组织建设,调整科室领导结构,注重员工专业素质培养等措施,全面促进病案科建设,使医院病案管理质量和服务能力得以提升。

The medical records management exposed many problems in the review of the hospital, such as weak management of the department, shortages existing in the knowledge structure of the staff and work responsibility, which influenced the construction of the department and brought many adverse effects to the informatization construction as well as electronic medical records of the hospital. Focused on the problems existing in the factual work of the hospital, we had made relevant rectification in the self-inspection before the review of the hospital. Through conducting measures such as strengthen the organization construction of the department, adjust the structure of leaders and put emphasis on the cultivation of professional quality of the staff, could we promote the construction of medical record department, as well as improve the management quality of medical records and service ability at the same time.