县区级超声质量控制管理体系建设的探索

Construction of ultrasonic quality control management system in primary hospitals

目的总结宁波市鄞州区超声医学质量控制管理中的工作,通过质量控制管理预期达到提升区域基层单位医疗技术和服务能力。方法2012年5月至2019年12月对宁波市鄞州区基层医院进行超声质量控制管理,分别从依法执业、医疗安全、诊疗环境、仪器设备、规范操作、建立质控制度及规范化检查及诊断7个方面进行,比较质量控制前后的基层超声医师具备医师资格证书、医师执业证书及执业范围为医学影像及放射治疗的比例情况;有无设立危急值报告制度及建立危重患者抢救流程及预案;诊疗环境及仪器设备有无提升;仪器操作的规范性;制度建立的完整性;检查及诊断的规范化。组间比较根据数据是否正态分布及方差齐性选择采用方差分析或非参数检验,组间两两比较采用LSD-t检验。结果基层医院的质控工作通过统一的《鄞州区超声质控考核方案》统一考核,2012年至2019年考核分数逐年增加,2012年、2013年、2014年、2015年内中心级与非中心级医院考核分数,差异均有统计学意义(t=17.469、15.825、7.308、43.958、3.350,P均<0.05),中心级医院考核分数显著高于非中心级医院。2016年内中心级与非中心级医院考核分数,差异无统计学意义(P均>0.05)。2017年、2018年、2019年整体比较考核分数中心级、非中心级、民营医院3组间比较,差异均有统计学意义(F=577.202、337.263、353.738,P均<0.001)。中心级、非中心级及民营医院质量控制工作逐年完善,中心级及非中心级基层医院的考核情况好于民营医院。2012年至2019年,无执业医师证书及执业范围不符的上岗超声医师逐年递减。建立严格的查对制度、危急值报告制度、院感控制建立并熟悉科室危重病紧急抢救预案、科室人员掌握CPR技术的比例要求,2012年至2019年全区未发生重大的医疗纠纷及医疗投诉;2012年诊间面积不达标共计13家,至2016年诊间面积不达标基层医院的数量逐年减少。2017年将民营医院纳入考核范围后诊间面积不达标情况有增加,至2019年也逐年减少。全区截至2019年底,共有88台彩色多普勒超声诊断仪,全区所有彩色超声仪器完成计量检测,老旧仪器数量减少;通过技能培训,规培基层医师超声操作,全区超声报告实现计算机图文报告,图像资料存档;建立十项超声质控制度,通过专科学习、专家下基层技术带教、建立鄞州区统一报告模板、制定质控管理指标等举措规范化的检查及诊断。鄞州区2012至2019年基层医院诊断阳性率及符合率逐年递增。结论鄞州区超声质量控制体系的不断完善,提高了基层医师的超声诊断水平,基层医院的超声质量控制得到提升,初步达到区域超声诊断的同质化管理。

Objective To summarize the work of regional ultrasonic quality control management and improve the medical technology and service ability of regional grass-roots units through quality control management.Methods The ultrasonic quality control was carried out in the primary hospitals of Yinzhou District,Ningbo City,and the differences before and after the quality control were compared from seven aspects:legal practice,medical safety,diagnosis and treatment environment,instruments and equipment,standard operation,establishment of quality control system,and standardized inspection and diagnosis.Based on whether the data followed a normal distribution and homogeneity of variance,analysis of variance or nonparametric test was used for comparison among groups,and LSD-t test was used for comparison between two groups.Results The quality control in primary hospitals was carried out through the unified Yinzhou District ultrasound quality control assessment program.From 2012 to 2019,the examination scores of central and non-central level hospitals had significantly increased year by year(t=17.469,15.825,7.308,43.958,3.350,all P<0.05).The examination scores of central-level hospitals were significantly higher than those of non-central-level hospitals.In 2016,there was no significant difference between central-level and non-centrallevel hospitals.In 2017,2018,and 2019,there were significant differences among central,non-central,and private hospitals(F=577.202,337.263,353.738,P<0.001).The number of ultrasound doctors who were not certified and did not match the scope of practice decreased year by year.By establishing a strict check-up system,emergency reporting system,hospital sense control,the emergency rescue plan for critical diseases in the department,and the proportion of the department staff who have mastered CPR,there were no major medical disputes or medical complaints in the whole region from 2012 to 2019.The number of hospitals with quality control environment for diagnosis and treatment increased year by year;88 color ultrasonic instruments were tested in basic hospitals in the region,and the number of old instruments decreased.Through skill training of basic-level doctors for ultrasonic operation,computer picture and text report was realized in the whole region,and the image data were archived.Standardized inspection and diagnosis through college study,technical teaching by experts at the grass-roots level,establishment of a unified reporting template in Yinzhou District,development of quality control management indicators,and other measures were also adopted.Conclusion Continuous improvement of the quality control system improves the level of ultrasonic diagnosis in primary hospitals.It is expected to achieve regional homogeneity of ultrasonic diagnosis.