Analysis and management strategy of inter-departmental general consultation

中华医院管理杂志 Pub Date : 2019-11-02 DOI:10.3760/CMA.J.ISSN.1000-6672.2019.11.009

Shuangxia Dong, Tao Yu, Zhi-jie Xia, Xuedong Xu, W. Fu

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Abstract

Objective To explore characteristics of general inter-departmental consultations in a hospital and put forward management strategy suggestions. Methods A large tertiary general hospital in Beijing was cited as the research object. Data were extracted from the EMR of the in-hospital inter-departmental consultations from July 1, 2017 to June 30, 2018, including information such as applying departments, submission time, invited departments, consultation completion time among others. Also collected were data such as discharges, case combination index(CMI), and preoperative average hospitalization days of clinical departments. Pearson and Spearman methods were used to perform correlation analysis, and independent sample Wilcoxon rank sum test was performed for the mean comparison. Results The ratio of consultations to discharged patients was 0.44, while consultation workload of cardiovascular medicine, ophthalmology and neurology was higher, and consultation applications issued by neurology, rheumatology and endocrinology departments were higher.For surgical departments, the correlation between demand of consultations and CMI was strong, r=0.63(P<0.05). The completion rate of consultation within 24 hours was 90.08%, and 64.79% of overtime consultations were caused by 35.63% of the consultation physicians. Conclusions It is imperative to enhance infrastructure support and information system construction to meet huge demands of inter-departmental consultations and to ensure patient safety; To further examinations of consultation purposes and improve doctors′ integrative abilities of diagnosis and treatment by introducing HIM mode to the training system, for the purpose of reducing unnecessary consultations; Optimize the process, shorten preoperative average length of stay by bringing forward inpatient-consultations to outpatient department; Inspire consultation enthusiasm and ensure consultation quality through performance appraisal mechanism. Key words: Case management; Consultation; Case mix index; Holistic integrative medicine; Efficiency

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跨部门会诊分析及管理策略

目的探讨医院综合性跨部门会诊的特点，提出管理策略建议。方法以北京某大型三级综合医院为研究对象。数据取自2017年7月1日至2018年6月30日住院跨部门会诊的电子病历，包括申请科室、提交时间、邀请科室、会诊完成时间等信息。还收集了出院、病例组合指数（CMI）和临床科室术前平均住院天数等数据。Pearson和Spearman方法进行相关性分析，独立样本Wilcoxon秩和检验进行平均值比较。结果会诊与出院患者的比例为0.44，心血管内科、眼科、神经内科的会诊工作量较大，神经内科、风湿病科、内分泌科的会诊申请较多。对于外科，会诊需求与CMI之间的相关性很强，r=0.63（P<0.05）。24小时内会诊完成率为90.08%，64.79%的加班会诊是由35.63%的会诊医生引起的。结论必须加强基础设施支持和信息系统建设，以满足跨部门会诊的巨大需求，确保患者安全；通过在培训体系中引入HIM模式，进一步检验会诊目的，提高医生的诊疗综合能力，减少不必要的会诊；通过将住院咨询提前到门诊部，优化流程，缩短术前平均住院时间；通过绩效考核机制，激发咨询热情，确保咨询质量。关键词：案例管理；咨询；病例组合指数；整体医学；效率

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中华医院管理杂志

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