PDCA管理模式对乳腺超声诊断质量改进的价值

The value of PDCA management model in improving the quality of breast ultrasound diagnosis

目的探讨PDCA管理模式对改进乳腺超声诊断质量的价值。方法选取2021年1月1日至12月31日期间华中科技大学同济医学院附属协和医院乳腺结节手术患者,均行乳腺超声BI-RADS分类诊断并进行随访。以病理结果为金标准,统计不同BI-RADS级别恶性率及乳腺癌首次治疗前超声诊断符合率。引入PDCA循环管理模式,对乳腺超声诊断质量进行分析、学习和整理。再用同样的方式随访2022年1月1日至12月31日期间本院超声科的乳腺超声诊断。对比两次随访结果。结果2022年医院乳腺结节超声诊断BI-RADS 3类、4a类结节恶性率较2021年更接近BI-RADS分类指南推荐恶性率(均P<0.05);超声诊断BI-RADS 4b、4c及5类结节恶性率差异无统计学意义(均P>0.05);2022年较2021年乳腺疾病首次治疗前超声诊断符合率由90.4%(1592/1761)提高至95.9%(1806/1884)。结论PDCA管理模式有助于提高乳腺超声BI-RADS分类诊断质量,更好的协助临床诊疗。

Objective To explore the value of Plan-Do-Check-Act(PDCA)management model in improving the quality of breast ultrasound diagnosis.Methods From January 1 to December 31,2021,patients undergoing breast nodule surgery in the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected for breast ultrasound Breast Imaging Reporting and Data System(BI-RADS)classification diagnosis and follow-up.Using pathological results as the gold standard,the malignant rate of different BI-RADS grade and the coincidence rate of ultrasound diagnosis of breast cancer before the first treatment were analyzed.PDCA cycle management mode was introduced to analyze,learn and sort out the quality of breast ultrasound diagnosis.The same method was used to follow up the breast ultrasound diagnosis in the ultrasound department of our hospital from January 1 to December 31,2022.The results of two follow-up visits were compared.Results sCompared with 2021,the malignancy rates of category 3 and 4a BI-RADS diagnosed by ultrasonic diagnosis of breast nodules in hospitals in 2022 were closer to the malignancy rates recommended by the classification guidelines of BI-RADS(all P<O.05).There was no significant difference in the malignant rate of BI RADS 4b,4c and 5 types of nodules(all P>0.05).In 2022,compared with 2021,the ultrasound diagnosis coincidence rate before the first treatment of breast disease increased from 90.4%(1592/1761)to 95.9%(1806/1884).Conclusions PDCA management mode is helpful to improve the classification and diagnosis quality of breast ultrasound BI-RADS,and better assist clinical diagnosis and treatment.