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目的建立并持续改进基于医院信息化平台的危急值处置管理流程,控制影响因素,缩短处置周期,提高临床处置质量。方法整合信息系统与危急值相关的数据采集、阈值设置和报告应答的流程,实现危急值全程信息化管理。分析2014年3月和12月住院患者危急值处置数据变化,比较危急值处置持续改进前后的成效。结果 2014年12月与3月相比,标本采集用时中位数由15.3 min降到12.79 min,运送用时中位数由69.15 min降到45.61 min,检测用时中位数由31.25 min降到29.25 min,危急值应答用时中位数由2.80 min降到1.63 min(P<0.01)。住院患者的急诊检验医嘱开立到危急值应答总用时中位数由160.55 min降到105.32 min(P<0.01)。危急值临床处置率由89.71%上升为98.61%,处置病程记录完成率由70.59%上升为90.28%。结论在信息系统支持下实施急诊检验危急值全程管理,可有效控制危急值报告处置周期,改善临床处置效率和质量,提升医疗安全水平。
Objective To establish and continually improve the critical value disposal management process based on hospital information platform, control the influencing factors, shorten the disposal cycle and improve the quality of clinical treatment. Methods Integrate the process of data collection, threshold setting and reporting response related to critical value of the information system to realize the whole information management of critical value. The change of critical value data of hospitalized patients in March and December 2014 was analyzed to compare the effectiveness before and after continuous improvement of critical value treatment. Results The median time of collection of specimens decreased from 15.3 min to 12.79 min in December 2014 compared with March, while the median time to delivery decreased from 69.15 min to 45.61 min. The median time to detection decreased from 31.25 min to 29.25 min , The median critical value of response decreased from 2.80 min to 1.63 min (P <0.01). The median number of emergency examinations prescribed for inpatients until the critical value was lowered from 160.55 min to 105.32 min (P <0.01). The critical value of clinical treatment rate increased from 89.71% to 98.61%, the completion rate of disposal of disease records increased from 70.59% to 90.28%. Conclusions The implementation of emergency management of emergency value in the whole process under the support of information system can effectively control the reporting period of critical value, improve the efficiency and quality of clinical treatment and improve the level of medical safety.