在问责制和质量改进之间找到正确的平衡:一个下放摘要及时性故事
Mark Goldszmidt1, Tsan-Hua Tung2, Alan Gob2
1Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada mark.goldszmidt@schulich.uwo.ca.
BMJ open quality
|May 9, 2025
概括
改善出院摘要身份验证对于患者安全至关重要. 虽然质量改进计划达到了目标,但持续的成功和编辑对实习生教育的影响需要进一步关注.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
- 医学教育 医学教育
背景情况:
- 及时的出院摘要 (48小时内) 对于安全的患者护理过渡和减少再入院至关重要.
- 学术医疗中心经常面临挑战,在满足监管任务,及时出院摘要认证的挑战.
- 实施了一项质量改进计划,以应对急症医疗团队的这些挑战.
研究的目的:
- 在一年内,将在48小时内认证的排放摘要比例从62%提高到75%.
- 评估质量改进倡议对放电摘要认证及时性的影响.
- 评估编辑行为和身份验证时间之间的关系.
主要方法:
- 一个以改善模式框架为指导的质量改进倡议.
- 结果指标:在48小时内验证的排放摘要的百分比和验证的平均时间.
- 使用前后设计与统计过程控制图表 (P图表,XbarS图表) 的数据分析.
主要成果:
- 增加及时认证的主要目标得到了实现,但没有持续.
- 完成简要认证的平均时间从53小时大幅减少到38小时,并保持稳定.
- 在身份验证之前进行编辑与更长的身份验证时间和实现48小时目标的可能性较低有关.
结论:
- 虽然该倡议提高了及时性,但缺乏持续的初级成果突显了持续监测的必要性.
- 缩短验证时间是临床上有意义的改进.
- 编辑行为,验证时间和实习生编辑减少之间的关联引起了医学教育和质量评估的担忧.
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