品管圈在超声诊断新生儿胆道闭锁持续质量改进中的应用效果

Effect of quality control circle activity in improving coincidence rate of neonatal biliary atresia diagnosed by ultrasound

目的探讨品管圈在提高超声诊断新生儿胆道闭锁符合率中的应用效果。方法于2019年4月至2019年11月开展品管圈活动,通过确定活动主题、计划拟定,收集2018年4月至2018年11月在广东省妇幼保健院超声诊断科进行新生儿胆道闭锁筛查的283例患者进行回顾性分析;以手术结果或胆道造影结果为“金标准”,进行超声诊断符合率调查和漏误诊原因分析;设定活动目标并拟定对策,于2019年4月至11月实施拟定对策、确认效果并持续实施;对2018年4月至2018年11月(改善前)与2019年8月至11月(改善后)的超声诊断符合率进行比较,采用χ^2检验。结果开展品管圈活动后发现,超声报告有对应病理或胆道造影的病例数为35人次,其中超声诊断与病理或胆道造影符合的病例数27人次,超声诊断与手术或胆道造影不符合的病例数8人次,胆道闭锁的超声诊断符合率为77%,超声诊断新生儿胆道闭锁中符合率由品管圈活动改善前的43%升至改善后的77%,差异有统计学意义(χ^2=6.810,P<0.05)。结论品管圈可有效提升超声诊断新生儿胆道闭锁符合率,提升超声医学专业质量管理能力。

Objective To investigate the effect of quality control circle(QCC)activity in improving the coincidence rate of neonatal biliary atresia diagnosed by ultrasound.Methods The QCC activity was carried out from April 2019 to November 2019.By determining the theme of the activity and drawing up the plan and taking the results of operation or cholangiography as the standard,a retrospective analysis was performed on the coincidence rate of ultrasonic diagnosis and reasons of missed diagnosis and misdiagnosis based on 283 patients who underwent neonatal biliary atresia screening at the Department of Ultrasonic diagnosis of Guangdong Maternal and Child Health Hospital from April 2018 to November 2018.Based on the data,the goal and the measures were determined,confirmed,and implemented continuously from April to November 2019.The coincidence rate of ultrasonic diagnosis before the implementation of the measures(from April to November 2018)was compared with that after the implementation of the measures(from April to November 2019).Results After the QCC activity,it was found that the number of cases who had pathology or cholangiography report and underwent ultrasound was 35,of which 27 had consistent diagnoses by ultrasound and by pathology or cholangiography,and the coincidence rate of ultrasonic diagnosis of biliary atresia was 77%.The coincidence rate of ultrasonic diagnosis of neonatal biliary atresia increased from 43%to 77%after implementing the QCC activity,and the difference was statistically significant(P<0.05).Conclusion The QCC activity can effectively improve the coincidence rate of ultrasonic diagnosis of neonatal biliary atresia and improve the professional quality management ability of ultrasonic medicine.