手术能力考评体系在手术分级管理中的应用

Application of the Operative Ability Evaluation System in Surgical Classification Management

目的结合手术分级管理要求,初步建立医师手术能力考评体系,通过考评结果了解各临床外系科室的情况。方法通过文献检索、现场问卷调查及专家咨询等方法,建立以临床操作技能评估(direct observation of proceduralskills,DOPS)为核心的医师手术能力考评体系。该体系包括了DOPS技能评估、非计划再次手术和年内手术量三个方面的考核。运用此体系对医院8个科室129名外科医生进行评估,并对评估结果进行比较。结果采用t检验,提示外系科室中耳鼻咽喉科、骨科和妇产科高于整体水平(t=2.42、2.18、2.35,P=0.03、0.04、0.02,P<0.05),胸外科、神经外科低于整体水平(t=-2.64、-2.63,P=0.02、0.03,P<0.05),眼科、泌尿外科、普外科与整体水平无明显差异(t=0.83、-1.84、-1.17,P=0.43、0.86、0.25,P>0.05)。结论外科各科室之间的考核结果存在差异,医院需积极关注薄弱科室,根据考核结果强化培训和监督,保证患者医疗安全。

Objective According to requirement of the surgical classification management, to establish the system of physicians’ surgical ability system. By the results of skill scores, to understand the situation of different operative departments. Methods Through literature review, field questionnaire investigation and expert consultation, the physicians’ surgical ability examination and evaluation system based on direct observation of procedural skills（DOPS）was established. The system included DOPS, non-plan reoperation and surgical numbers .129 surgeons were evaluated by this system . Results The scores of surgeons in E.N.T Dept, Dept of Orthopaedics, Obstetrics and Gynecology Dept were significantly higher than average level （t=2.42, 2.18, 2.35,P=0.03, 0.04, 0.02,P〈0.05）. The scores of surgeons in Thoracic Surgery and Neurosurgery were significantly lower than average level （t=-2.64, -2.63, P=0.02, 0.03,P〈0.05）. There was no significant difference in scores of surgeons in Ophthalmic Dept, Urology Surgery and General Surgery Dept with average level（t=0.83, -1.84, -1.17,P=0.43、0.86、0.25,P〉0.05）. Conclusion The results show significant difference in operative departments. According to the result of system, medical managements should pay more attention to the weakness points of surgeons and enhance surgeons’ clinical practice to make the patients safety.