品管圈在构建县域综合医院腹痛中心新模式管理中的应用

The application of quality control circle in the construction of a new model management of abdominal pain center in county general hospital

目的探讨品管圈(QCC)在构建县域综合医院腹痛中心新模式中应用的效果。方法选择白银市中心医院急诊科2021年6月至2022年10月收治的160例非创伤性腹痛患者作为研究对象,以2022年3月为界,2021年6月至2022年2月未成立QCC管理模式前收治的80例非创伤性腹痛患者实施常规救治及护理,2022年3月至10月成立QCC管理模式后收治的80例非创伤性腹痛患者实施QCC管理模式,确立QCC主题后,按照QCC活动10大步骤,设定目标,圈员根据攻坚点逐一拟定方策并进行方策第1次和第2次展开,通过可行性、经济性、迫切性、圈能力进行评价,制定腹痛患者救治方案,开展规范化救治,选择最适方策实施与反思,最后进行效果评价,比较未成立QCC前与成立QCC后有形成果(院前急救平均反应时间、院内急救平均反应时间、腹部专项检查等待时间、会诊等待时间、急诊科滞留时间、急诊进入手术时间、分诊准确率、护理质量及不良事件发生率)和无形成果(圈员解决问题能力、个人素质修养、责任心、沟通协调能力、自信心、团队合作能力、积极性、QCC手法掌握程度)的差异。结果①有形成果:QCC后院前急救平均反应时间、院内急救平均反应时间、腹部专项检查等待时间、会诊等待时间、急诊科滞留时间、急诊进入手术时间均较QCC前明显缩短〔院前急救平均反应时间(min):2.15±0.05比4.25±0.25,院内急救平均反应时间(min):58.32±10.25比100.22±25.25,腹部专项检查等待时间(min):29.78±6.44比40.22±8.59,会诊等待时间(min):9.05±2.12比13.15±3.12,急诊科滞留时间(min):58.60±9.25比76.00±12.02,急诊进入手术时间(min):115.25±20.25比153.22±25.32,均P<0.05〕,分诊准确率较QCC前明显提高〔98.75%(79/80)比87.50%(70/80),P<0.05〕,不良事件发生率较QCC前明显降低〔16.25%(13/80)比35.00%(28/80),均P<0.05〕。②无形成果:实施QCC后,圈员解决问题的能力、个人素质修养、责任心、沟通协调能力、自信心、团队合作能力、积极性、QCC手法掌握程度评分均较QCC前有了很大提高〔解决问题能力评分(分):3.75±0.26比2.89±0.19,个人素质修养评分(分):3.76±0.24比2.92±0.28,责任心评分(分):3.63±0.22比3.20±0.33,沟通协调能力评分(分):4.25±0.30比3.20±0.33,自信心评分(分):3.52±0.30比2.90±0.19,团队合作能力评分(分):3.63±0.29比3.00±0.18,积极性评分(分):3.63±0.27比2.97±0.22,QCC手法掌握程度评分(分):3.38±0.22比2.91±0.27,均P<0.01〕,无形成果显著。结论开展QCC活动可以提高腹痛患者救治管理水平,提升医疗质量。

Objective To explore the application effect of quality control circle(QCC)in the construction of a new model for abdominal pain centers in county-level comprehensive hospitals.Methods A total of 160 patients with non-traumatic abdominal pain admitted to the department of emergency of Baiyin Central Hospital from June 2021 to October 2022 were selected as research objects.Divided by March 2022,from June 2021 to February 2022,and 80 patients with non-traumatic abdominal pain admitted to the department of emergency before the establishment of QCC management mode from June 2021 to February 2022 were given routine treatment and nursing care.After establishing the QCC theme,the targets were set according to the 10 steps of QCC activities,the circle members drew up the strategies and carried out the second development of the strategies one by one,evaluated the feasibility,economy,urgency and circle ability,formulated the treatment plan for the patients with abdominal pain,carried out the standardized treatment,selected the most suitable method to carry out and review,and finally evaluated the effect.The difference of tangible outcomes(the average response time for pre hospital emergency treatment,average response time for inhospital emergency treatment,waiting time for abdominal special examination,consultation waiting time,emergency department retention time,and emergency surgery entry time,triage accuracy,incidence of adverse events)and nontangible outcomes(problem-solving ability,personal qualities,sense of responsibility,communication and coordination ability,self-confidence,teamwork ability,enthusiasm,and mastery of QCC)between pre-and post-QCC patients were compared.Results①Tangible results:after QCC,the average response time for pre hospital emergency treatment,average response time for in-hospital emergency treatment,waiting time for abdominal special examination,consultation waiting time,emergency department retention time,and emergency surgery entry time were significantly shortened compared to before QCC[pre hospital emergency response time(minutes):2.15±0.05 vs.4.25±0.25,average response time for in-hospital emergency treatment(minutes):58.32±10.25 vs.100.22±25.25,waiting time for abdominal special examination(minutes):29.78±6.44 vs.40.22±8.59,consultation waiting time(minutes):9.05±2.12 vs.13.15±3.12,emergency department retention time(minutes):58.60±9.25 vs.76.00±12.02,emergency surgery time(minutes):115.25±20.25 vs.153.22±25.32,all P<0.05],triage accuracy significantly improved compared to before QCC[98.75%(79/80)vs.87.50%(70/80),P<0.05],incidence of adverse events significantly decreased compared to before QCC[16.25%(13/80)vs.35.00%(28/80),P<0.05].Intangible achievements:after the implementation of QCC,circle members had significantly improved their problem-solving ability scores,personal qualities scores,sense of responsibility scores,communication and coordination ability scores,self-confidence scores,teamwork ability scores,enthusiasm scores,and mastery of QCC scores compared to before QCC(problem-solving ability scores:3.75±0.26 vs.2.89±0.19,personal qualities scores:3.76±0.24 vs.2.92±0.28,sense of responsibility scores:3.63±0.22 vs.3.20±0.33,communication and coordination ability scores:4.25±0.30 vs.3.20±0.33,self-confidence scores:3.52±0.30 vs.2.90±0.19,teamwork ability scores:3.63±0.29 vs.3.00±0.18,enthusiasm scores:3.63±0.27 vs.2.97±0.22,mastery of QCC scores:3.38±0.22 vs.2.91±0.27,all P<0.01),with significant intangible achievements.Conclusion Conducting QCC activities can improve the management level of abdominal pain patients and enhance the quality of medical care.