医护一体化工作模式在创面修复学科建设中应用的探索

Exploration on the working mode of Integration of Medical and Nursing on the discipline construction of wound repair

目的:探索高效的创面修复学科管理模式,完善创面修复学科建设。方法:改变临床工作中医患、护患两条平行线的格局,建立医护一体化工作模式,以“关注慢创患者、方便群众就医”为指导思想,通过院前“医院、社区、家庭一体化”、院中“门诊、住院一体化”、院后“治疗、康复一体化”以及创面修复专科医联体等方式,开展院前、院中、院后医护一体化创面修复无缝隙管理模式。结果:2017—2019年,我院创面修复中心出诊人次连续2年增长率都在30%以上。2017—2019年,门诊患者由3451人次增长到16437人次,住院患者从563人次增长到1042人次,平均住院日由(49.3±2.4)d降低到(24.2±3.1)d,创面愈合率从45.6%提高到89.6%,药占比从19.2%降至14.3%,平均住院费用从(2.43±0.21)万元降至(1.37±0.20)万元。结论:医生和护士共同参与的医护一体化创面修复管理模式,可全面系统评估、处理、治疗、管理创面,有利于加速慢性创面患者康复,降低治疗费用,增加患者满意度。

Objective:To explore a more effective management mode of wound repair discipline,and improve the discipline construction of wound repair.Methods:The working mode of Integration of Medical and Nursing was established to alter the previous pattern of two parallel lines of doctor-patient and nurse-patient;taking“pay attention to the patients with chronic trauma,and facilitating the masses to seek medical service”as the guiding ideology.The coherent management mode of Integration of Medical and Nursing in wound repair was carried out pre-hospital,inhospital and post-discharge by means of integration of hospital,community and family pre-hospital,integration of outpatient and inpatient in hospital,and integration of treatment and rehabilitation post-discharge,as well as cooperation with Wound Repair Specialist Medical Union.Results:From 2017 to 2019,the number of house calls increased by more than 30%for two consecutive years in the wound repair center of our hospital;the number of outpatients increased from 3451 to 16437,and of inpatients increased from 563 to 1042;the average hospitalization decreased from(49.3±2.4)days to(24.2±3.1)days,the wound healing rate increased from 45.6%to 89.6%,the proportion of drugs decreased from 19.2%to 14.3%,and the average hospitalization expenses decreased from(24300±2100)yuan to(13700±2000)yuan.Conclusions:The doctors and nurses jointly participated management mode of Integration of Medical and Nursing for wound repair can evaluate,treat and manage the wounds comprehensively and systematically,which is conducive to accelerating the rehabilitation of patients with chronic wounds,reducing treatment costs and increasing patient’s satisfaction.