CAJ | 학술논문

目的：了解我院重症医学科质量控制现状，发现、分析薄弱环节，为进一步提高我院ICU质控提供依据。方法收集我院ICU 2012年1月~2013年12月“结构-过程-结果”评价系统的指标数据并进行回顾性分析。结果在结构指标中，学科建设基本符合国家要求，但其中专科医生配置和部分设备配置低于北京市二级医院平均水平；而24h获得的高级职称重症专科医师数量和年不良事件报告例数均低于北京市二级医院平均水平。在过程指标中，已建立患者转出的标准化程序，多学科查房频度、床位使用率接近二级医院水平但明显低于三级医院水平，而继续教育开展频度则低于北京市二级医院平均水平。在结果指标中，标准化死亡比、意外拔管率、48h内非计划再插管率介于三级医院和二级医院之间，48h再转入ICU发生率2012年偏高，2013年有所下降。中心静脉导管相关血流感染发生率与呼吸机相关肺炎发生率2012年水平高于或接近北京市三级医院水平，均高于二级医院水平，2013年较前有所下降。结论我院ICU质量控制指标总体介于北京市三级医院与二级医院之间，但在重症医学专科医生配置、高级职称重症专科医师数量、年不良事件报告例数、继续教育开展频度等方面存在较大的改善空间。对于结果指标中的中心静脉导管相关血流感染及呼吸机相关肺炎的控制仍是下一步质量控制与改进的重要干预环节。
목적：료해아원중증의학과질량공제현상，발현、분석박약배절，위진일보제고아원ICU질공제공의거。방법수집아원ICU 2012년1월~2013년12월“결구-과정-결과”평개계통적지표수거병진행회고성분석。결과재결구지표중，학과건설기본부합국가요구，단기중전과의생배치화부분설비배치저우북경시이급의원평균수평；이24h획득적고급직칭중증전과의사수량화년불량사건보고례수균저우북경시이급의원평균수평。재과정지표중，이건립환자전출적표준화정서，다학과사방빈도、상위사용솔접근이급의원수평단명현저우삼급의원수평，이계속교육개전빈도칙저우북경시이급의원평균수평。재결과지표중，표준화사망비、의외발관솔、48h내비계화재삽관솔개우삼급의원화이급의원지간，48h재전입ICU발생솔2012년편고，2013년유소하강。중심정맥도관상관혈류감염발생솔여호흡궤상관폐염발생솔2012년수평고우혹접근북경시삼급의원수평，균고우이급의원수평，2013년교전유소하강。결론아원ICU질량공제지표총체개우북경시삼급의원여이급의원지간，단재중증의학전과의생배치、고급직칭중증전과의사수량、년불량사건보고례수、계속교육개전빈도등방면존재교대적개선공간。대우결과지표중적중심정맥도관상관혈류감염급호흡궤상관폐염적공제잉시하일보질량공제여개진적중요간예배절。
Objective To investigate current situation of ICU quality control in our hospital , to find out the weakness in critical care medicine quality control of our ICU , provide a sound basis for improving our ICU quality control. Methods Col-lected and retrospectively reviewed the structure, process and outcomes quality control system parameters from Jan 2012 to Dec 2013 of ICU in our hospital. Results In structure parameters, subject reconstruction mainly fulfilled national requirements to provide intensive care. But the allocation of professional ICU doctor and partial equipment were inferior to Beijing second-class hospitals. And the structure parameters of 24h availability of a consultant level intensivist and adverse event reporting system al-so under the level of Beijing second-class hospitals. In process parameters , the standardized handover procedure for discharging patients had established. The level of presence of routine multi-disciplinary clinical ward rounds and the maintenance of bed oc-cupancy rates below a threshold level were between the third-class hospitals and second-class hospitals. But the level of the maintenance of continuing medical education according to national standards was obviously below the second-class hospitals. In outcomes parameters, the level of standardized mortality ratio, the rate of unplanned endotracheal extubations and the endotra-cheal re-intubation rate within 48h of a planned exbution were between the third-class hospitals and second-class hospitals. ICU re-admission rate within 48h of ICU discharge was higher in 2012 than that in 2013. The level of the rate of central venous catheter-related blood stream infection and the rate of ventilator associated pneumonia were higher or close to the third-class hospitals in 2012, which also dropped in 2013. Conclusion Although the level of our critical care medicine quality control is between the third-class hospitals and second-class hospitals of Beijing in general , however the allocation of professional ICU doctor, the parameters of 24h availability of a consultant level intensivist, adverse event reporting system and the maintenance of continuing medical education according to national standards should be improved. Central venous catheter-related blood stream infection and ventilator associated pneumonia are still extremely important points in critical care medicine quality control.