| [Purpose] An evaluation index based on the "structure-process-outcome" three-dimensional quality structure model(SPO management model)is constructed.By analyzing the medical quality improvement effect of the post-anesthesia care unit(PACU)after the implementation of the homogenization management in the first hospital and three districts of the case hospital,the PACU homogenization management mode under the background of the multi district development of the first hospital and the third class public hospital is summarized,and the corresponding optimization strategies are discussed.[Methods](1)Applying the methods of literature research and text analysis to analyze the homogenization management theory,medical service characteristics and homogenization management mode,and refine the key points of homogenization management;(2)Eight experts in the field of anesthesia were invited to evaluate and revise the elements of PACU homogenization management through expert group discussion,and the PACU quality evaluation index was established;(3)Field investigation method: PACU quality evaluation indexes are used to evaluate the quality of PACU in three hospital districts of the case hospital before and after the homogenization management and between the three hospital districts;(4)Data statistical analysis method:use descriptive analysis method,chi square test and other methods to analyze relevant indicators and quantitatively evaluate the effect of PACU homogenization management.[Results] 1.Based on the preliminary PACU quality evaluation indicators including 3first-class indicators,7 second-class indicators and 21 third-class indicators constructed by literature analysis,through expert group discussion,it is determined that there are 3first-class indicators including structure quality,process quality and outcome quality,6second-class indicators and 23 third-class indicators including management system,system management,human resource management,facility configuration,diagnosis,treatment and nursing process and patient outcome indicators.2.Effect evaluation:(1)In 2017,before the implementation of homogenization management in the case hospital,there were differences in the structure,process and result quality of PACU among the three hospital districts.Many quality indicators of the branch hospital districts were lower than those of the main hospital district.Among them,in terms of the qualified rate of first-aid articles,sterile articles,hand hygiene,nursing operation assessment,writing of nursing documents,correct execution of medical orders,satisfaction rate of nursing services,rate of hypothermia in the room and delay rate of transfer out,The main hospital area(94%,96%,94%,84%,98%,98%,96%,0.18‰,0.45‰)was superior to the branch hospital area 1(90%,96%,94%,79.17%,94%,96%,87.69%,0.35‰,1.22‰)and the branch hospital area 2(86%,92%,88%,83.33%,92%,100%,90%,0.21 ‰,0.83 ‰).The difference was statistically significant(P<0.05),indicating that the quality of the branch hospital area did not meet the quality of the main hospital area.(2)In 2021,three years after the implementation of homogenization management,the PACUs in the three hospitals and districts will basically achieve homogenization in terms of structure,process and result quality,Among them,the main hospital area(the qualified rate of first-aid articles is 100%,the qualified rate of sterile articles is 98%,the qualified rate of hand hygiene is 98%,the qualified rate of nursing operations is 98.67%,the qualified rate of nursing documents is 96%,the correct rate of medical orders is 100%,the satisfaction rate of nursing services is 99.20%,the rate of hypothermia in the room is 0.10 ‰,the rate of transfer out delay is 0.46‰,the rate of unplanned secondary intubation is 0.08‰,and the rate of unplanned transfer to ICU is0.87‰)Branch 1(100%,98%,98%,100%,98%,100%,100%,98%,100%,98.46%,0.08‰,0.57‰,0.16‰,0.83‰),branch 2(100%,100%,98%,100%,98.33%,0.11‰,0.57 ‰,0.11 ‰,0.83 ‰),and the difference is not statistically significant(P>0.05),indicating that there is no difference in PACU quality among the three hospitals in 2021.(3)The overall quality in 2021 was higher than that in 2017,mainly reflected in the quality improvement of the branch.However,as there are still deficiencies in manpower allocation and personnel titles,individual quality indicators of the branch hospital are still lower than those of the main hospital.Among them,in 2021,the qualified rate of first-aid articles in PACU was 100%,the qualified rate of hand hygiene was 98%,the qualified rate of nursing operation was 99.19%,the satisfaction rate of nursing service was 98.80%,the incidence rate of PACU complications was 1.08%,the rate of hypothermia in the room was 0.10‰,the rate of transfer out delay was 0.49‰,the rate of unplanned secondary intubation was 0.10‰,and the rate of unplanned transfer to ICU was 0.86‰,which was significantly better than that in 2017(90%,92%,82.93%,92.4%,1.86%,0.20‰,0.59‰,0.30‰,and 2.45‰,respectively),The difference was statistically significant(P<0.05),indicating that the service quality of PACU patients was significantly improved under the homogeneous management mode.3.The case hospital has implemented homogeneous management in the three hospital districts since 2018.Field investigation and analysis show that its homogeneous management mode includes five management elements: unified organizational structure,unified system management,unified personnel management,unified service process and unified quality control standard;A unified quality management system is the core.Under the dual management of the nursing department and the anesthesia department,the PACU quality management in the third hospital area implements homogeneous management through a unified management system,and finds and solves problems in time through dynamic quality evaluation and summary,so as to continuously improve the service quality.[Conclusion] Through the establishment of a unified management system and management process,and the implementation of a homogeneous management model,the medical service quality among different hospital areas has been homogenized.The quality of PACU has been significantly improved both in terms of diagnosis,treatment and nursing process indicators and patient outcome indicators.The case hospital homogenization management model can provide management reference for the development of more public hospitals in the future.Under the situation of the development of multi District homogenization of one institute,a complete homogenization management system should be established to standardize the organizational structure and management process.Through the construction and implementation of PACU homogenization management,we can improve patient outcomes,improve patient satisfaction,and finally achieve homogenized service quality. |
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