ObjectiveTo explore the application effect of standardized management on video-electroencephalogram (VEEG) monitoring.MethodsIn January 2018, a multidisciplinary standardized management team composed with doctors, technicians, and nurses was established. The standardized management plan for VEEG monitoring from outpatient, pre-hospital appointment, hospitalization and post-discharge follow-up was developed; the special quilt for epilepsy patients was designed and customized, braided for the patient instead of shaving head, standardized the work flow of the staff, standardized the health education of the patients and their families, and standardized the quality control of the implementation process. The standardized managemen effect carried out from January to December 2018 (after standardized managemen) was compared with the management effect from January to December 2017 (before standardized managemen).ResultsAfter standardized management, the average waiting time of patients decreased from (2.08±1.13) hours to (0.53±0.21) hours, and the average hospitalization days decreased from (6.63±2.54) days to (6.14±2.17) days. The pass rate of patient preparation increased from 63.14% to 90.09%. The capture rate of seizure onset increased from 73.37% to 97.08%. The accuracy of the record increased from 33.12% to 94.10%, the doctor’s satisfaction increased from 76.34±29.53 to 97.99±9.27, and the patient’s satisfaction increased from 90.04±18.97 to 99.03±6.51. The difference was statistically significant (P<0.05).ConclusionStandardization management is conducive to ensuring the homogeneity of clinical medical care, reducing the average waiting time and the average hospitalization days, improving the capture rate and accuracy of seizures, ensuring the quality of medical care and improving patient’s satisfaction.
ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
ObjectiveTo investigate the application and effect of quality control circle (QCC) in the management of hand hygiene for nurses in hemodialysis center. MethodsQCC was applied in the management of hand hygiene in hemodialysis center from March 2013 to February 2014. Factors affecting the compliance and correctness of hand hygiene in hemodialysis nurses were analyzed, and counter measurements were established and applied. Moreover, effect of QCC management was also assessed. ResultsAfter the application of QCC, the compliance and correctness of hand hygiene in hemodialysis nurses increased significantly from 41.02% to 88.46% (P<0.05) and 46.88% to 91.30% (P<0.05), respectively. Moreover, maneuver application, team spirit, professional knowledge, communication and cooperation among nurses were also increased by QCC management. ConclusionThe application of QCC can not only increase the compliance and correctness of hand hygiene in hemodialysis nurses but also improve team cohesiveness, which is worth recommendation and promotion.
Objective To analyze and compare the domestic quality standard and foreign quality standard of sodium hyaluronate (HA), and to expatiate on the critical process monitoring parameters. Methods Different quality standards of HA were compared by translating and sorting, and some experimental data were analyzed as well as the manufacturing practice was elaborated. Results Differences exist in raw materials standard or specifications of products between domestic and foreign, but the basic control points are concordant. Conclusion The company should set up reasonable and controllable quality standard based on quality requirements and related process characteristics so as to assure the safety and effectiveness of the clinical application.
Objective To compare product standards of drug and medical device made from sodium alginate and calcium alginate between domestic and abroad, and to emphases on the process parameters monitoring based on different standards. Methods Sodium alginate and calcium alginate standards of both domestic and foreign were analyzed and summarized, and the differences and commonalities of various product standards among each standard were compared. Results Differences exist in product standards of sodium alginate and calcium alginate between domestic and abroad, whether drug or medical device, but the fundamental control points are concordant. Conclusion Companies should focus on product quality control requirements combined with its own unique manufacturing process characteristics to develop reasonable and controllable quality standards, which can ensure safe and effective clinical use.
Objective To evaluate the application effect of quality control circle (QCC) in improving the number of cases received in the follow-up management of chronic kidney disease (CKD). Methods The outpatient and inpatient CKD patients who were filed in the CKD follow-up management center of West China Hospital of Sichuan University from March 10 to October 10, 2020 were selected. We analyzed the reasons that affected CKD patients’ willingness to file by carrying out QCC, improved the case collection by establishing standardized processes, broadened the collection channels, established a collective team, strengthened training management and education of CKD patients and their families, so as to increase the number of cases received in CKD follow-up management. Then, we observed the score of active ability of QCC members before and after this activity. Results After the implementation of QCC activities, the number of follow-up cases increased from 8 per month to 15 per month. The target achievement rate was 140%, and the progress rate was 87.5%. The ability of all circle members in the evaluation indicators of team training has been improved. Conclusions QCC activity can effectively improve the number of cases received in CKD follow-up management. It is helpful for the medical staff to provide better disease management for CKD patients.
ObjectiveTo investigate the current situation of orthopedic quality control and management in county-level regional general hospitals in Guangdong, and to provide a scientific basis for further standardizing the procedures of orthopedic quality control and management in county-level regional general hospitals and continuously improving the work of provincial orthopedic quality control center.MethodsFrom June 2019 to July 2020, online and offline questionnaire survey and field survey were used to investigate the quality control and management of orthopedic departments in 22 county-level regional general hospitals in Guangdong.ResultsAmong the overall scores of the surveyed hospitals, the highest score was 96.5, the lowest score was 72.0. There were 6 hospitals with a total score of “excellent” (accounting for 27.3%). The “facilities and equipment” and “medical quality” of the surveyed hospitals were relatively valued. Taking Guangzhou, the capital of Guangdong as the center, the districts and counties were divided into the east, the south, the west and the north regions, and the difference in overall scores of orthopedics among the four regions was statistically significant (F=6.299, P=0.004). The unqualified rates of department setting, key technology development, average hospitalization days of representative diseases, equipment allocation, personnel allocation, department management and building layout were relatively high, which were 77.3%, 63.6%, 45.5%, 40.9%, 40.9%, 36.4% and 36.4%, respectively. Most hospitals had set up special debridement rooms in orthopedic department (95.5%), and the management and monitoring of the use of antibacterial drugs was mostly reasonable (90.9%). In terms of the level of orthopedic medical treatment, only 3 hospitals with sufficient key technologies reached the standard, accounting for 13.6%, and only 7 hospitals reached the standard of scientific research capacity, accounting for 31.8%. In terms of quality control, the numbers of hospitals with qualified medical record sampling (72.7%), perfect management and supervision mechanism (86.4%) and quality management team in departments (77.3%) were the least. In addition, among the investigated hospitals, beds were in short supply in orthopedic departments, with 12 hospitals accounting for 54.5% being deducted; 16 hospitals (72.7%) were deducted for unqualified doctor-patient ratio and 11 hospitals (50.0%) were deducted for unqualified nurse-patient ratio.ConclusionsThe overall level of orthopedics construction and management in the surveyed hospitals is uneven. The medical professional and technical level is insufficient. It is difficult to meet the practical needs, and there is an imbalance in the ratio of medical personnel. In the future, it is necessary to strengthen the quality control of orthopedic medical care, strengthen the medical technology training of county-level regional general hospitals and increase the medical and health resources and capital investment, so as to improve the quality control of county-level regional general hospitals.
ObjectiveTo monitor surgical quality and analyze learning curve of minimally invasive mitral valve replacement (MVR)through right minithoracotomy with cumulative sum analysis (CUSUM analysis). MethodsClinical data of 60 consecutive patients who underwent minimally invasive MVR through right minithoracotomy in the Fourth Affiliated Hospital of Guangxi Medical University from June 2011 to April 2013 were retrospectively analyzed. There were 32 male and 28 female patients with their age of 28-53 (34.67±7.11)years and their heart function ranging from NYHA class Ⅱ to Ⅳ. There were 31 patients with mitral stenosis (MS), 19 patients with mitral regurgitation (MR), and 10 patients with MS and MR. According to the surgical sequence, all the patients were divided into 3 groups (group A, B and C)with 20 patients in each group. Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics and CUSUM curves. ResultsAortic cross-clamp time, cardiopulmonary bypass time and operation time of group C were significantly shorter than those of group A and group B (aortic cross-clamp time of group C vs. group A:50.35±2.30 minutes vs. 66.15±8.38 minutes; operation time of group C vs. group B:167.50±4.63 minutes vs. 178.60±4.49 minutes, P < 0.05). In-hospital mortality was 3.3% (2/60). CUSUM analysis showed a significant learning curve effect, although surgical quality remained in control during the study period. Surgical failure rate was lower than 80% after about 45 operations, indicating that failure rate was 10% lower than expectation. ConclusionMinimally invasive MVR is safe and reliable, and CUSUM analysis is a simple statistical method to monitor surgical quality.
ObjectiveTo discuss the application and effect of PDCA cycle in urgent values management in surgical intensive care unit. MethodsWe analyzed the quality of 141 cases of urgent value reports in surgical intensive care unit from May to July 2013 before the application of PDCA management. The quality of urgent values were totally controlled by PDCA circle. There were 135 cases of urgent value reports after the use of PDCA cycle. The data including qualify rate of specimens, record specification rate, and handover of urgent values were compared between the two groups of urgent values. ResultsAfter the application of PDCA cycle management, the awareness rate of urgent value content and disposal processes among medical staffs increased from 75% to 95%, with significant improvement in the quality rate of samples, recording and processing of urgent values and the quality rate of recording. ConclusionThe application of PDCA circle management can constantly correct the problems and ensure the policy implementation in the urgent values system in clinical departments, which can promote continuous quality improvement.
In recent years, with the increasing attention of health administrative departments and medical institutions at all levels to hospital infection, the prevention and control of hospital infection is increasing. As an important part of the quality control network, the role of provincial quality control center has a very important impact on the effectiveness of quality control work. Since its establishment, “Gansu Provincial Medical Quality Control Center of Hospital Infection Management” has actively explored the quality control mode suitable for the provincial situation, continuously strengthened the basic hospital infection quality control work, and innovated the quality control forms, especially the special quality control activities of “Infection Prevention in Gansu Province” with the core content of “supervision, training and investigation” carried out in combination with the provincial situation, which has created a new quality control work mode of the provincial quality control center. It is recognized and promoted by the national counterparts, and playes a positive role in promoting the management of hospital infection in the whole province. This article expounds the supervision practice of “Infection Prevention in Gansu Province” from four aspects in detail.