乳腺良性肿瘤治疗中临床路径变异因素分析及措施

Clinical Pathway Variation Factors Analysis on the Treatment of Benign Breast Tumor and Relevant Countermeasures

目的探讨分析乳腺良性肿瘤切除术后患者各种变异因素以及采取的相应措施,便于临床路径更好推广使用。方法将某院乳腺科2014年11月-2016年11月两年间,乳腺良性肿瘤切除术住院患者1212例临床路径病例出现变异情况进行分析,找出导致变异的原因,并制定相应的改进措施。结果研究发现252例患者变异发生率为20.79%,与患方相关的变异占53.57%,主要为合并其他基础疾病;与医务人员相关的变异发生率占39.29%,主要为术前评估不到位;与医院系统相关的变异为7.14%,医院之间检查检验结果互认。结论临床路径变异主要与患方和医务人员的因素有关,可通过完善流程设计、加强过程管理、充分评估病情三方面加以干预,将部分可控变异内容融入文本、提高病情评估准确性,从源头上减少变异发生,最终达到临床路径质量持续改进的目的。

Objectives To explore and analyze the variation factors in patients after benign breast tumor resection and relevant countermeasures, so as to make better promotion of clinical pathway. Methods To conduct analysis on 1212 cases of patients after benign breast tumor resection with clinical pathway variation in breast surgery department during the two years from November 2014 to November 2016, find out the causes of variation, and make corresponding improvement measures. Results The study found that 252 cases of patients with the mutation occurrence rate was 20.79%, variation associated with patients accounted for 53.57%, mainly associated with other underlying diseases; variation associated with the incidence of medical personnel accounted for 39.29%, mainly for the preoperative assessment is not in place; variants associated with hospital system is 7.14%, the hospital inspection results recognition. Conclusions The variation of clinical pathway was mainly related to the medical staff,we could make intervention from three aspects such as improve the process design, strengthening process management and fully assess the condition. Part of controllable content could integrated into text, improve the condition variation in the accuracy of the evaluation, to reduce the occurrence of variation from the source, and achieve the purpose of continuous improvement of quality of clinical pathway ultimately.