内分泌科转科与非转科患者不适当住院日现状及其影响因素分析

Status quo of unreasonable hospital stay and its influencing factors in transferred and untransferred patients at department of endocrinology

目的探讨某三级综合医院内分泌科转科与非转科患者不适当住院日现状及其影响因素。方法采用机械抽样法抽取某三级综合医院内分泌科1280例患者(1280份病案资料,共12288个住院日),其中未转科患者、转入患者、转出非手术患者、转出手术患者均为320例,住院日分别为2272 d、3136 d、3296 d、3584 d。运用文献研究结合专家咨询建立评价方案,逐一对各类别患者的住院日进行评价,结合帕累托图对不适当住院日产生的原因进行分析。结果(1)60.31%的住院患者存在不适当住院日,总住院日中有21.74%为不适当住院日,高于国内常模。不适当住院日构成中,80.15%由转科患者引起,仅19.85%由未转科患者引起。(2)导致非转科患者存在不适当住院日的原因主要涉及医院原因和患者原因;转出非手术患者存在不适当住院日主要是由医院原因引起;转出手术患者存在不适当住院日的原因主要来源于医院、患者、社会3方面。(3)调整后样本医院平均住院日可降低2.1 d,其中转出手术患者可降低天数最多(2.7 d),非转科患者可降低天数最少(1.4 d)。结论不适当住院日受不同层面的诸多因素影响,且贯穿于患者的整个诊疗过程。应当重视减少不适当住院日对提升医院管理效能的积极作用,并对其产生的原因加以分析,从根本上降低不适当住院日。

Objective To investigate the status quo of unreasonable hospital stay and its influencing factors in transferred and untransferred patients at endocrinology department of a tertiary general hospital.Methods Systematic sampling method was used to select 1280 patients,with 1280 medical records and 12288 inpatient days in total,at endocrinology department of a tertiary general hospital,wherein untransferred patients,transferred-in patients,transferred-out nonsurgical patients and transferred-out surgical patients amounted to 320 cases,and their hospital stay was 2272 days,3136 days,3296 days and 3584 days,respectively.The evaluation scheme was established using literature study combined with expert consultation,then the assessment of hospital stay was performed on patients of various categories separately,and the causes of unreasonable hospital stay were analyzed based on Pareto chart.Results(1)About 60.31%of the inpatients had unreasonable hospital stay.Unreasonable hospital stay accounted for 21.74%in total inpatient days,which was higher than the domestic norm.In terms of unreasonable hospital stay constitute,80.15%of unreasonable hospital stay was found in transferred patients,and only 19.85%in untransferred patients.(2)The causes resulting in unreasonable hospital stay in untransferred patients mainly involved hospital issues and patient issues;unreasonable hospital stay in transferred-out nonsurgical patients was commonly caused by hospital issues;unreasonable hospital stay of transferred-out surgical patients was mainly due to hospital,patient and society.(3)After adjustment,the average hospital stay of the sample hospital was reduced by 2.1 days,the maximum decrease of hospital stay(2.7 days)was found in transferred-out surgical patients,and the minimum decrease(1.4 days)was found in untransferred patients.Conclusion Unreasonable hospital stay is affected by various factors of different levels,occurring throughout the process of diagnosis and treatment of the patients.It′s necessary to pay attention to the positive effect of reducing unreasonable hospital stay on the improvements in hospital management efficacy,and analyze its causes,thus diminishing unreasonable hospital stay fundamentally.