183家二级医院检验危急值报告调查与分析

Survey and Analysis on the Critical Value of 183 Second-Tier Hospitals

目的了解河北省二级医院危急值制度的建立、危急值项目的选择、危急值界限的设定和危急值报告与审核等,为加强危急值管理、持续改进提供帮助。方法随机选择河北省200家二级医院,发放电子或纸质问卷,调查内容包括医院基本情况、检验危急值制度的建立、危急值项目的选择、危急值界限的设定、危急值报告的复查与发放等。结果河北省200家二级医院中有183家回报了有效结果,回报率为91.5%,各医院均建立了危急值制度,危急值项目中WBC、PLT、血钾为选择最多的项目,选择凝血酶原时间、活化部分凝血活酶时间超过90%,而血糖、血钙和血气列为危急值项目的并不高;部分医院在设定危急值界限时进行了性能验证、评估医院整体医务人员经验和能力、抢救措施以及不同科室对危急重疾病的救治能力和技术水平;在危急值报告管理方面,仍以人工识别危急值为主,多采用电话通知的方式告知临床,危急值结果审核、复检及其报告等方面存在不同意见。结论河北省二级医院在危急值制度管理方面进行了改进,但仍有许多不足,有些问题有待进一步探讨和研究。

Objective To investigate the second-tier hospitals in Hebei province in establishment of the critical value system,selected critical value projects,the critical value limit setting and critical value reporting and auditing in order to strengthen the critical value management,continuous improvement to provide better care.Methods Randomly selected 200 hospitals,by sending to E-mail or questionnaires. Survey contents included hospital basic situation,the ways of establishment of the critical value system,the selection of critical value project,the critical value limit settings,critical value of the report and review. Results Out of 200 second-tier hospitals surveyed,183 hospitals returnedthe acceptable results（ 91. 5%）. All 183 hospitals have set up critical value systems,the most selected projects are WBC,PLT,PT and APTT. Blood sugar,blood calcium and blood gas were not commonly selected as a critical value projects. Some hospitals performaned verification when setting critical value limits,assessed experience and ability of all staff in the hospitals,the rescue measures,and different departments on the critical condition of heavy volume treament capacity and technical performance. In critical value report management,giving priority to artificial identifingcritical value result,adopting the way of phone call to inform next specialties. There were different opinions in critical value result reporting,auditing,or reviewing. Conclusion Critical value system and its managementin second-tierhospitalin Hebei province has made improvement,but some problems remain to be further discussed and studied.