Construction And Application Of Two-level Triage Management Mode In Outpatient Department Of Dermatology Specialist Hospital

Objectives: To understand the application of triage mode in outpatient department of dermatology specialist hospital,The status of out-patient visits and nurses working in the sub diagnosis model,Analysis of related problems of outpatient triage exist,Based on the investigation of the current situation and the results of expert consultation,construction of Two-level Triage Management Mode,Through the clinical application,we evaluated the role of the triage mode in optimizing the outpatient triage mode,improving the triage efficiency,improving the level of nursing service and improving the patient's experience in medical treatment.The objective is to provide the basis for the standardization,standardization and institutionalization of out-patient services,and to provide a strong guarantee for the quality management and nursing service level of out-patient services.Methods:The first is literature review and summary,understanding of outpatient triage related management regulations,by investigation and analysis of the current outpatient triage problems,patients needs and satisfaction,triage nurse personnel structure and triage efficiency,provide a theoretical basis for the innovation of outpatient triage management mode;The second is on the basis of investigation preliminary construction of skin disease outpatient service two pre triage management mode,through two rounds of expert consultation,determine the two pre triage mode according to triage,triage indicators and specific content;Third is the training of triage nurses,to master the operation content two level triage mode,the mode of implementation of triage triage clinic patients,statistical analysis before and after use of the triage accuracy rate,waiting time,change the physician incidence and patient satisfaction,evaluate the application effect of the model to improve triage efficiency and improve patient experience,optimize outpatient triage mode etc..Reslts:(1)The results of the current situation survey:Survey of outpatient status:(1)In 2016,there were 652 thousand and 9 hundred people in the dermatology outpatient clinic,with a daily average of up to 2306 people,and the outpatient visits were high in the year;(2)At present,Department of dermatology outpatient specialties mainly include general department of Dermatology,dermatitis and eczema specialist,psoriasis specialist,vitiligo specialist,integrated traditional Chinese and Western medicine,fungi and medicine,medical beauty specialist,skin surgery,skin laser,skin loss and skin characteristics,ten specialties;(3)The current outpatient triage mode for the first visit after the registration into a triage a waiting mode.Survey of Outpatient:(1)The average age of the patients was(29.97±11.52)years,and the patients with queuing time less than 15 minutes accounted for 15.87%,15-30 minutes of patients accounted for 16.73%,30-45 minutes of patients accounted for 23.14%,45-60 minutes of patients accounted for 29.57%,60 minutes of patients accounted for 15.87%;(2)The number of registered information returned error accounted for 22.42%,The time interval was not suitable accounted for 19.39%,The inconsistency of medical treatment accounted for 15.76%,The waiting time is too long account for 13.94%,The replacement of the expert account for 12.12%,The doctor recommended replacement account for 7.88%,the doctor did not specify visits accounted for 6.06%,other causes accounted for 2.42%;(3)The overall satisfaction of the patients was(3.97±0.74),the visiting process was(3.81±1.09),the visiting environment was(3.90±0.82),the queuing time was(3.34±0.97),the nurse triage professional level was(4.28±0.81),and the humanistic care was(3.94± 3.94).Survey of nursing nurses:(1)Nurses' average age(25.81±3.85)years old,college education 10 people,accounting for 62.5%,The bachelor's degree is 6,accounting for 37.5%;There are 9 nurses,accounting for 56.25%,Nurse Practitioners is 5,accounting for 31.25%,Nurse-in-charge is 2,accounting for 12.5%;3 years work experience of less than 4,accounting for more than 25%,10 people 3 to 5 years,accounted for 62.5%,more than 2 people in 5 years,accounting for 12.5%;(2)The work of triage includes: providing information for patients,maintaining the order of patients,arranging patients' grading visits,assisting patients to choose doctors,remind patients to wait for treatment,coordinating visiting doctors,assessing patients' condition,recording and responding to patients' suggestions and so on;(3)Work pressure efficiency score of diagnosis(4.25±0.59),the difficulty of implementation is(3.96±0.71),the completion time is(4.04±0.59),the content is(4.52±0.51),the operation complexity is(4.22±0.75),the level of technology is(3.19±0.68),the demand satisfaction degree is(3.74±0.90).(2)Two level triage management mode,after two rounds of expert consultation to establish firs level 4 triage basis,7 diagnosis indexes,21 indexes,second level 4 triage basis,18 triage index,17 specific indexes,the enthusiasm of experts was 100%,authority the coefficient reached 0.9,the coordination coefficient of experts on consulting content reached 0.663,the coordination degree is good,high reliability of the consulting.(3)Two level triage mode in the application study,two groups of triage accuracy compared with conventional group was 89.08% and 96.01% in the intervention group;two groups of average waiting time compared to the conventional group(47.07±20.57)min,the intervention group(35.76±16.98)min;two groups of physicians replacement occurred the rate of more than 13.24% in conventional group,the intervention group was 3.25%;compared two groups of patients' satisfaction,the routine group in the treatment process,medical environment,waiting time,professional level,humanistic concern five aspects of the scores were(4.75±0.45),(4.56±0.63),(4.06±0.68),(4.69± 0.48),(4.38±0.62),intervention group(3.12±1.02),(3.5±0.82),(2.69±0.79),(3.94±0.93),(3.56±0.96),the differences were statistically significant.Conclusion:First,the number of outpatient medical treatment in dermatology hospital is huge,the nursing resources of the triage are limited,and the existing triage mode is difficult to implement accurate and effective triage.Therefore,we need to build a triage mode suitable for the current treatment status and improve the quality of triage;The second,the two level triage mode,further emphasizes the important role of diagnosis before previewing and effective evaluation,pay attention to distinguish the disease under the specialist,understanding the needs of the patients and the severity of the disease,to achieve effective triage of patients,shorten the waiting time of patients to reduce the phenomenon of return,and plays an important role in improving efficiency,improve patient triage nurse treatment experience,optimize outpatient triage mode,from the essence of real play value of triage.