2020年某省级三甲医院临床检验危急值分析及改进

Analysis and Improvement of the Critical Value of Clinical Examination in a Provincial Tertiary Hospital in 2020

目的危急值管理可以有效降低医疗风险,在一定程度上避免医疗纠纷、医疗过错的发生,提升医院医疗质量管理水平。为推动危急值管理体系的持续改进,统计并分析2020年临床检验危急值数据。方法回顾性分析某省级三甲医院2020年临床检验危急值发生率、科室分布情况及危急值单项占比等,并提出持续改进意见。结果临床检验危急值项目共18项,2020年临床检验危急值总数19017例,发生率为2.79%。发生危急值最多的科室是重症监护病房(ICU),其次是消化内科、血液内科,占比分别为25.92%、19.38%、11.72%。危急值排名前5的项目分别为:白细胞(WBC)、血小板(PLT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、肌钙蛋白T(TNT),占比分别为17.04%、16.69%、12.85%、9.45%、9.07%。发生率较高的前5项危急值的前3名科室分布情况如下。WBC:血液内科、肿瘤内科、妇科,占比分别为30.24%、10.98%、9.78%。PLT:血液内科、ICU、消化内科,占比分别为28.99%、21.15%、12.54%。CK-MB:ICU、消化内科、新生儿重症监护病房(NICU),占比分别为36.46%、21.81%、8.47%。MYO:ICU、心外科、消化内科,占比分别为31.05%、18.14%、17.58%。TNT:ICU、心外科、消化内科,占比分别为36.48%、24.88%、15.31%。结论在危急值制度管理过程中要定期进行总结分析,不断完善及修订适合自己医院的危急值项目及范围,提高工作效率及医疗服务质量。

Objective Critical value management can effectively reduce medical risks,avoid medical disputes and medical errors to a certain extent,and improve the level of hospital medical quality management.In order to promote the continuous improvement of the critical value management system,the critical value data of clinical tests in 2020 were collected and analyzed.Methods The incidence of critical value,the distribution of departments and the proportion of critical value items in a provincial tertiary hospital in 2020 were retrospectively analyzed,and suggestions for continuous improvement were put forward.Results There were a total of 18 critical value items for clinical testing.In 2020,the total number of critical values in clinical examination was 19017 cases,and the incidence rate was 2.79%.The department with the most critical value was Intensive Care Unit(ICU),accounting for 25.92%,followed by Gastroenterology(19.38%)and Hematology(11.72%).The top 5 critical value items were white blood cell(WBC),platelet(PLT),creatine kinase isoenzyme(CK-MB),myoglobin(MYO),and troponin T(TNT),accounting for 17.04%,16.69%,12.85%,9.45%and 9.07%respectively.The distribution ratios of the top 3 departments of the top 5 critical values with the highest incidence were as follows.WBC:Hematology,Oncology and Gynecology,accounting for 30.24%,10.98%and 9.78%respectively.PLT:Hematology,ICU and Gastroenterolog,accounting for 28.99%,21.15%and 12.54%respectively.CK-MB:ICU,Gastroenterology and Neonatal Intensive Care Unit(NICU),accounting for 36.46%,21.81%and 8.47%respectively.MYO:ICU,Cardiac Surgery and Gastroenterology,accounting for 31.05%,18.14%and 17.58%respectively.TNT:ICU,Cardiac Surgery and Gastroenterology,accounting for 36.48%,24.88%and 15.31%respectively.Conclusion In the critical value system management process,it is necessary to regularly summarize and analyze,and continuously improve and revise the critical value items and scope suitable for their own hospital,which can improve work efficiency and medical service quality.