中国循证医学杂志

中国循证医学杂志

2013~2015 年安徽省重症医学科质量控制情况的横断面调查

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目的 对安徽省重症医学科(intensive care unit,ICU)医疗质量控制情况进行基线调查,为发展安徽省 ICU 提供科学基础。 方法 通过电子问卷方式对全省范围内 108 家医院 ICU 2013~2015 年质量控制相关指标进行调查。运用 SPSS 20.0 统计软件对结果进行数据分析及统计描述。 结果 共收到来自 108 家医院的有效问卷 110 份,其中三级医院 43 家,二级医院 65 家。110 个 ICU 中 96.36% 为综合性 ICU。各级医院 ICU 平均床位数为(14.46±7.12)张,占医院总床位数(1.58±1.04)%。执业医师床位比与注册护士床位比分别为(0.57±0.24)∶1,(1.54±0.79)∶1。29 家医院(26.36%)满足 ICU 总床位数与医院总床位数比值在 2%~8% 之间。仅 5 个(4.55%)ICU 满足每张床位占地面积不低于 15 m2。ICU 患者呼吸机相关肺炎、导管相关血流感染及导管相关泌尿系感染平均发生率分别为(17.30±15.36)‰、(3.07±3.93)‰和(3.49±4.27)‰,且三级医院 ICU 感染发生率高于二级医院。尚无 ICU 实现 19 项关键技术全部开展。42.73% 的科主任从事本专业年限为 10 年以上。仅有 2.73% 的医院 ICU 工作人员的绩效分配高于全院平均水平。 结论 安徽省 ICU 始建至今取得全面快速发展,成立范围覆盖所有市级医院及超过 80% 的县级医院,但面临着医疗资源不足、人才梯队建设滞后、学科整体业务水平不高、专科人员缺乏、工作强度大、绩效分配低等一系列制约学科发展的问题。建议未来进一步完善 ICU 质量控制体系、规范质量控制流程、健全并执行 ICU 规范化操作标准、加强学科人才梯队建设,以保障医疗质量和安全。

Objective To investigate the baseline of quality control system for intensive care unit (ICU), and to provide a scientific basis for the development of ICU in Anhui province. Methods A questionnaire was used to investigate the quality control indexes in 108 hospitals in Anhui province from 2013 to 2015. SPSS 20.0 statistical software was used to analyze and statistically describe the survey results. Results A total of 110 questionnaires from 108 hospitals were received, including 43 tertiary hospitals and 65 secondary hospitals. In these 110 ICUs, 96.36% were integrated ICU. The total average number of ICU beds was 14.46±7.12, accounting for 1.58%±1.04% of the total hospital beds. The ratios of practicing physicians-beds and registered nurses-beds were 0.57±0.24: 1 and 1.54±0.79: 1, respectively. A total of 29 hospitals (26.36%) met the conditions that the ratio of the total number of beds in the ICU to the hospital was 2% to 8%. Only 5 ICU (4.55%) could meet the conditions that each bed covered an area ≥15 m2. The average incidence of ventilator-associated pneumonia, catheter-related blood stream infection and catheter-related urinary tract infection in ICU patients were (17.30±15.36) ‰, (3.07±3.93) ‰, and (3.49±4.27) ‰, respectively. The incidences in the tertiary hospitals were higher than the secondary hospital. There was no ICU to achieve all 19 key technologies. 42.73% directors of ICU engaged in the professional career more than 10 years. Only 2.73% of the medical institutions in the intensive medical staff performance distribution than the average level of hospital. Conclusion ICU in Anhui province has been achieved a rapid development, and has covered all municipal hospitals and more than 80% of the county-level hospitals. But it confronts with a series of problems, such as lack of medical resources, the construction of talent echelon lag, low overall level of discipline, lack of specialist, work intensity, low performance and a series of constraints which restricted the development of disciplines. It strongly suggests that we should further improve the quality control system of critical care medicine, standardize the quality control process, improve and implement the standardized operation standard of critical care medicine, strengthen the construction of disciplines talent echelon. We are expected to enhance the overall level of discipline and to ensure medical quality and safety.

关键词: 安徽省; 重症医学科; 质量控制; 基线调查

Key words: Anhui province; Intensive care unit; Quality control; Baseline survey

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