第三次四川省中医医院重症医学科质控工作现状调查及分析

Third investigation and analysis of quality control situation of intensive care unit in traditional Chinese medicine hospitals in Sichuan Province

目的分析四川省中医医院重症医学科(ICU)质控发展现状及趋势,为提高我省中医医院(含中西医结合医院、民族医院)ICU诊疗水平提供依据.方法四川省中医重症医学质控中心于2018年9月成立督导组,并于2018年10月8日至17日按照《中医重症医学质控督导项目评分标准》对四川省具有独立ICU的中医医院进行了为期10 d的质控工作业务指导,针对ICU基础条件、医疗技术队伍、医疗服务能力与水平、病区质量、重症医学核心指标完成情况、中医质控完成情况、新技术开展情况、优势病种诊疗方案等8个方面进行调查和评分.结果全省共52家中医医院具有独立ICU,其中三级医院33家(占63.5%),二级医院19家(占36.5%);省级医院5家(占9.6%),市级医院20家(占38.5%),县级医院27家(占51.9%).平均ICU床位占比约1.8%;医床比及护床比分别为0.71∶1、2.0∶1;年均收治患者率、年均收治床日率较高,均基本达1%;病区质量高,院感发生率均控制在10%以下;感染性休克集束化治疗达标率高,呼吸机插管、中心静脉导管、导尿管感染发生率分别为0.45%、0.22%、0.30%;中医参与率约83.4%;新技术开展数量平均约4.4项;优势病种方案平均约2.62种.结论四川省中医医院ICU在医疗服务能力与水平、病区质量、重症医学质控指标、中医参与率方面均达到指南要求,但在ICU规模、医护人员配置、新技术开展、优势病种诊疗方面仍需加强.

Objective To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU. Methods Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases. Results There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6%(5/52), 38.5%(20/52), and 51.9%(27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71∶1 and 2.0∶1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high;the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62. Conclusions ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.