某三级综合性医院手术分级管理模式探讨

Proposal of the mode on the surgery grading management in a general tertiary hospital

目的分析某综合性三级甲等医院医师手术分级管理现状,针对当前手术分级管理制度落实中存在的问题与难点,进一步探索医院手术分级精细化管理模式。方法调取医院电子病历系统中2021年的手术数据,运用SPSS 18.0软件建立数据库,采用率、构成比进行描述性统计分析,用卡方检验对科室不同级别医师施行的手术级别情况进行比较分析。结果医院手术分级科学性和管理信息化程度有待加强;尚存在医师越级手术现象,越级手术比例为0.21%,副主任医师越级比例最高,占其主刀手术量的0.58%;医师降级手术现象普遍,89.35%的一、二级手术是由副主任及以上医师主刀,主任医师降级手术占其总手术量的70.09%。结论为加强手术分级管理,应实行手术分级目录动态调整,建立院科两级联动的手术分级及授权管理和绩效分配体系,运用信息化手段实现手术分级动态管理。

Objective To analyze the current status of surgery grading management in a general tertiary hospital,identify the problems and difficulties in the implementation of the current system,and explore a refined management mode of surgery grading in hospitals.Methods The surgical data of the hospital's electronic medical record system in 2021 were collected.SPSS 18.0 was used to establish a database for descriptive analysis on adoption rate and composition ratio.The chi-square test was used to compare and analyze the grades of surgeries performed by surgeons with different academic titles.Results The surgery grading system and the informationization need to be strengthened.There was still phenomenon of skipping grade surgeries with a rate of 0.21%.Associate chief physicians had the highest ratio,accounting for 0.58%of the surgeries they performed.Lower-grade surgeries performed by surgeons with higher academic titles were common,89.35%of the grade 1 and 2 operations were performed by associate chief physicians and above,and the lower-grade operations by chief physicians accounted for 70.09%of their total surgeries.Conclusion In order to strengthen the surgery grading management,dynamic adjustment of surgery-grading catalog should be implemented.Hospitaldepartment linkage system and authorization management,and distribution system based on performance should be established.The dynamic management of surgery grading should be realized by means of information technology.