PDCA循环在降低临床路径变异率的应用

Application of PDCA Circulation to reduce the Variation Rate of Clinical Pathway System

目的通过PDCA循环管理办法降低某院临床路径系统变异率,以达提高医疗质量。方法由相关科室组成PDCA持续改进小组,遵循PDCA循环确立临床路径系统变异率目标值、明确真因、实施对策,并对比改善前(2019年1月1日-2019年3月31日)和改善后(2019年9月1日-2019年11月30日)的5524例临床路径病例在变异率和医疗资源消耗情况。结果经过本轮PDCA工作,临床路径管理变异率由改善前的56.52%降至改善后的27.53%,科室的变异率达标率由改善前3.23%提高至改善后45.16%;同时,住院费用由改善前的(15571.75±32339.83)元降至改善后的(13801.69±23133.88)元,住院药品费用由改善前的(2889.37±5736.66)元降至改善后的(2552.53±6228.36)元(P<0.05)。结论通过PDCA循环分析及发现临床路径管理工作中存在的问题,成功降低了临床路径的变异率,提高了临床路径的执行质量。

Objective Through PDCA cycle management method to reduce the variation rate of clinical pathway system in a hospital.Method The PDCA continuous improvement team was established by the quality control department,medical department,nursing department,pharmacy department and information department.The target value of variation rate of clinical pathway system was determined,the real cause was identified and the implementation countermeasures were implemented according to the four stages and eight steps of PDCA cycle.5524 cases of clinical pathway cases were selected from January 1 st,2019 to November 30 th,2019,and the improvement effect was checked evaluation to form a set of standardized management process.Results After this round of PDCA work,the variation rate of clinical pathway management decreased from 56.52%to 27.53%,and the variation rate of departments increased from 3.23%to 45.16%.At the same time,the hospitalization cost decreased from 15571.75($32339.83)to 13801.69($23133.88),and the hospitalization drug cost decreased from 2889.37($5736.66)to 2552.53($6228.36)(P<0.05).Conclusions Through PDCA cycle analysis and finding the problems in clinical pathway management,the variation rate of clinical pathway was successfully reduced and the execution quality of clinical pathway was improved.