Study On Nursing Costs About Vaginal Delivery

Objective:(1)To define the nursing items of the vaginal delivery maternal during the hospitalization and the operation content of the nursing item,to provide the basis for the nursing manager to regulate the vaginal delivery care process,thereby improving the quality of care;(2)According to the established nursing item and the content of each project service Nursing cost accounting,in order to calculate the total cost of care during the hospitalization of vaginal delivery maternity,provide an objective basis for the allocation of nursing human resources and the relevant decision-making departments to develop reasonable care service prices,and provide a basis for other single disease care cost accounting and Methodological guidance.Methods: Based on extensive literature review,medical record review and on-site investigation,the materials involved in the vaginal delivery care project and the nursing item are established,and the definition of the nursing service is determined through literature review and panel discussion;the natural care related nursing item is adopted by the expert consultation method.The project's technical difficulty,project labor intensity,project risk degree,nurse's own characteristics and patient's situation are divided into five categories: the cost relative value method is used to calculate the cumulative value of the influencing factors obtained by the expert assignment,and the reference item is selected.Calculate the labor cost RVU value of the nursing item;measure the single nursing operation time by using the working hour measurement method;use the expert consultation method to classify the accounting project and the apportioned project and calculate which accounting items are allocated to the accounting project;apply the time-driven activity costing method to the apportioned project and the indirect cost was shared;the frequency of nursing items during the hospitalization of 115 natural maternal hospitals was counted by on-site investigation and medical record review;the statistical analysis of the data used EXCEL2016 Chinese version and SPSS 21.0 statistical analysis software.Results: A total of 61 vaginal delivery related nursing items were established,including 36 basic nursing items and 25 special nursing items.This study obtained RVUvalues of 25 special projects and measured the operation time of 25 vaginal delivery care projects;Obtain 18 items of apportionment and 43 items of accounting.After apportioning the apportioned items and indirect costs,calculate the cost of single item care,and verify the average standard frequency of the care items.Calculate the total cost of vaginal delivery care between 1132.79-1240.54 yuan;The average actual nursing charge of vaginal delivery for pregnant women during hospitalization is 215.51 yuan,excepting the fee of deliver,accounting for 7.57% of hospitalization expenses.The actual cost of basic project care is much larger than the cost of accounting care.The top six cases of vaginal delivery single care work are single birth delivery,hearing fetal heart rate,observing contractions,newborn bath,perineum scrubbed and measuring TPR.Conclusions: In the process of nursing cost accounting for vaginal delivery,the cost accounting components of the vaginal delivery nursing items have certain feasibility,and the accounting results reflect the consumption of various costs in the service.The management of labor cost and material cost is an important part of nursing cost management;And the time-driven activity costing method and resource-based relative value scale method are applicable to the nursing cost accounting,which can reflect the labor payment of the nursing staff more comprehensively and objectively;The existing nursing charging project can not fully include the clinical actual nursing items,the current charges for vaginal delivery is unreasonable,and the decision-making department of government can adjust the pricing with based on certain criteria.