某妇女儿童医院的非医嘱离院之原因剖析

Cause Analysis on Discharged Patients without Doctor's Advice in Women & Children's Hospital

目的通过回顾性分析2017年3月-6月的非医嘱离院的病案,剖析其构成原因,为科室医疗质量管理提供依据。方法应用描述性统计方法列出2017年3月-6月1075份非医嘱离院患者的科室及疾病分布情况,从而分析各科非医嘱离院的具体原因。结果非医嘱离院的科室由高到低依次:产科(35.26%)、新生儿科(18.98%)、儿科(18.98%)、外科(6.89%)、内科(4.09%)、妇科(3.44%)、乳腺科(0.56%)。位列前三位的科室在疾病分布上也具有明显特征,产科的各类原因的安胎监护占非医嘱离院的比例最高;新生儿科则以与早产相关的呼吸系统疾病作为最高比例;儿科是以呼吸系统疾病为最高。结论医院应根据非医嘱离院的人群分布集中的科室,有针对性对产科、新生儿科及儿科进行科学管理干预,作出适当的出院指导,从而有效减少非医嘱离院带来的负面影响和不良的医疗结局。

Objective By reviewing cases of discharged patients without doctor＇s advice, relevant factors are disclosed to provide the basis for hospital management. Methods Describe general distribution of care unit and diseases composition of 1075 cases of discharged patients without physician＇s advice from March to June this year.Then reveal the relevant factors in every care unit in this kind of group. Results The percentage of 1075 cases is listed from highest to lowest： Obstetrics（35.26%）,Neonatology（18.98%）,Pediatrics（18.98%）, Surgery（6.89%）,Internal Medicine（4.09%）, Gynecology（3.44%）, Breast（0.56%）. There are significant characteristics on the top 3 care units. The percentage of all kinds of custody guardianship in Obstetrics is the highest; respiratory disease in relation with premature birth is top one in Neonatology; while respiratory disease is the most common in Pediatrics. Conclusion Based on the distribution of discharged patients without doctor＇s advice. Hospital should interfere with medical treatment among Obstetrics, Neonatology and Pediatrics purposely. Doctors should give correct guidance to every patient according to his age and illness so as to reduce negative impacts and unpleasant consequences of discharged without doctor＇s advice effectively.