浙江省51家民营医院检验科质量现状与改进建议

Quality status and improvement measures for clinical laboratories at 51 private hospitals in Zhejiang province

目的调研浙江省民营医疗机构的检验质量状况并提出改进对策。方法选择浙江省内床位大于100张的51家民营医院检验科作为研究对象，统一发放基本信息调查问卷；实地调研民营医院检验科的质量现状，内容包括规章制度、质量体系、室内质控、室间质评、各项检验质量保证措施等；发放尿常规、生化常规和乙肝定性三类专业的盲样标本并要求限时回报。将部分调查结果与浙江省公立二级医院进行比较。结果多数民营医院在检验人员继续教育培训、室间质评参加率、室内质控规范性及分析能力、危急值、复检率、仪器维护保养、信息化等方面落后于公立医院。未参加室间质评检验科的盲样不合格率明显高于已参加室间质评者。结论民营医院检验科应平衡经济效益与医疗质量的关系，参加室间质评，加强继续教育培训，将超出自身能力的检验项目外送第三方检验机构，重视常规检验项目的质量控制。质量监管部门要加强外部质量监管，将民营医院检验科和第三方检验机构共同纳入检验质量考核体系中，提高民营医院检验质量，保障医疗安全。

Objective To survey the laboratoriesr quality of private medical institutions in Zhejiang province and to propose improvement measures. Methods Information questionnaires were distributed to 51 private hospitals with beds over 100 in Zhejiang province. Site investigations were made to these hospitals,covering rules and regulations, quality systems, IQC, EQA, quality assurance measures among other items. Blind specimens for urine routine, routine biochemical tests and qualitative hepatitis B tests were also distributed to each clinical laboratory, requiring report return within a deadline. Results Private hospitals lagged behind secondary public hospitals in CME, EQA participation rates, normative and analytical skills of IQC, critical values, recheck rates, instrument maintenance and information technology. The blind sample failure rates of laboratories absent in the EQA were significantly higher than that of the laboratories present. Conclusions Private hospitals should maintain a good balance between their business gains and quality of care. They are recommended to participate in the EQA, strengthen their continuing education training, send the test items beyond their abilities to third-party laboratories,and pay attention to quality control of routine test items. Quality regulatory authorities should strengthen external quality supervision to both private hospitals and third-party laboratories, which can effectively improve the detection quality and ensure the safety of medical treatment.