ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
Under the vigorous promotion of national policies, by the end of 2018, the construction of the national medical consortium has been fully launched, and all public tertiary hospitals have actively participated in the construction of medical consortium. The practice of lead-type close medical consortium in West China Hospital of Sichuan University is an innovative exploration in the context of the new national medical reform. Combining the social responsibilities, location characteristics, functional orientation of West China Hospital of Sichuan University, and the remarkable results of the lead-type close medical consortium, this article elaborats three distinctive features of the lead-type close medical consortium, namely the cooperation between the government and the hospitals as the cornerstone, the hierarchical collaboration as the core, and the medical care and great health as the guiding principle, to provide a reference for the construction of a high-quality and efficient medical and health service system in China.
China is facing the serious situation of 2019-novel coronavirus (2019-nCoV) infection. The health care institutions have actively participated in the prevention, diagnosis, and treatment of the disease. Proper regulation of in-hospital policy may help control virus spreading. We developed seven key clinical questions about the prevention and control of 2019-novel coronavirus infection in hospital, and provided recommendations based on the best available evidence and expert experience. We interpreted the recommendations for better feasibility in Chinese hospital. The current recommendations provide evidence and reference for the domestic medical institutions to reasonably adjust the hospital workflow during 2019-nCoV infection period..
ObjectiveTo understand the inpatient classification and influence factors of hospitalization expenses, so as to provide basis for hospital management. MethodsThe diagnosis and treatment data of inpatients in a grade A tertiary hospital in 2013 were collected, the percentile method were used to describe the expenses distribution, the K-means clustering method was applied to classify the inpatients, the rank-sum test was utilized to analyze the differences of the costs among different groups, ICD-10 was applied to analyze the diseases distribution, and the median regression was used to analyze the influence factors. ResultsThere were 175 333 inpatients in total. The median of the expenses was 10 016.31 yuan RMB. The inpatients might be classified into seven groups with different expenses (P=0.0001). For inpatients who had no "blood transfusion cost", the top three factors of cost category were operation, laboratory test, examination; for who had "blood transfusion cost", the top three factors of cost category were blood transfusion, laboratory test, examination. There were 2 147, 2 182, 1 499, 1 301, 2 059, 22 and 14 kinds of diseases (ICD-10 four-digit code) respectively among the seven groups. The influence factors could be summarized into patient-related and diagnosis & treatment-related ones. ConclusionThe costs of operation, blood transfusion, laboratory test, and examination affect the inpatients classification greatly. The results could be of help to inform the admission of patients, the expense control and the disease management.
Objective To understand the outpatients, evaluation and demands of the real-name registration system. To implement the new medical reform program deeply. Methods We used the questionnaire named registration questionnaire of West China Hospital designed by ourselves to survey the outpatients and their family members and were filled in the questionnaire by themselves. Results Firstly, real-name registration system in West China Hospital made major contribution to alleviate the difficulties of registration and medical treatment. It achieved a major breakthrough and created a good social benefit. Secondly, patients the most favourite way of registration was by phone. They were satisfied with the platform of the social welfare services very much. Thirdly, the number of appointment registration arrived year by year, while the number of the day registration fell year by year. Conclusion Firstly, we innovate the form of the realname registration system, refine service and do scientific management at the needs of the patient-oriented. Secondly, we strengthen the track of the failure of appointment registration and analyze the causes. We should take measures timely to reduce the rate of the event and improve the real-name registration system. Thirdly, we strengthen the management of the out-patient doctor visiting program and credit services, to improve medical compliance rate and protect the interests of the patients. Fourthly, we explore a scientific research of out-patient real-name registration system to establish a modern hospital out-patient services model.
Objective To compare and analyze hospital operation and management models between China and foreign countries, in order to provide reference and guidance for the continuous improvement of hospital management in China. Methods The NVivo software was used to conduct a qualitative comparative analysis of domestic and foreign literature on hospital operation and management models in China National Knowledge Infrastructure, Wanfang, Web of Science, and PubMed until December 2022, and a model for the differences in operation and management between Chinese and foreign hospitals was further constructed. Results Finally, 33 Chinese literature and 21 English literature were selected as the raw materials for NVivo qualitative analysis. A comparative analysis of the operation and management models of Chinese and foreign hospitals from four dimensions: structure, process, results, and continuous improvement showed that there were differences in operation and management systems, talents, processes, finance, refinement, and innovation between Chinese and foreign hospitals. Conclusion Hospital operation and management needs to be deeply integrated with business work, improve the construction of hospital operation and management system, strengthen the competence of operation talents, pay attention to resource cost-benefit analysis, attach importance to the two-way integration of business and finance, optimize the adjustment of operation and management structure, and attach importance to the innovation drive of new technology application, in order to promote the scientific, standardized, refined, and informationalized level of hospital operation and management.
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
Through reviewing the implementation of outpatient appointment services around the whole country, the problems of current outpatient appointment services were analyzed, which included imperfect information platform, low rate of medical experts’ visit on schedule, high rate of breaking the appointment by outpatients, and the new inequity caused by opaque information on the outpatient appointment service. The strategies were put forward to address the problems, including the integration of different social resources, cooperation and sharing, enhancing supervision to increase experts’ visit rate, establishing a new model for outpatient appointment service to decrease the breaking of appointment, and opening information to ensure the fair and impartial appointment.
Objective To summarize and analyze the experience of Canadian hospital report, including report contents, indicators system and result application, so as to provide basis for improving Chinese hospital information report and enhancing healthcare regulation. Methods Official networks and databases in Canada were searched, and relative policies, documents, research reports and information reports were included. Results Canadian Hospital Report Project carried out by Canadian Institute for Health Information was effective for gathering and comparing hospitals’ information, and regulating healthcare service. Ontario Hospital Report Project, as a local policy based on national hospital report project, was a good example of local government to improve healthcare service regulation. Conclusion Canadian Hospital Report and Ontario Hospital Report enlighten us that, carrying out the comparison of hospitals in the same type, ensuring the comparability of data, setting comprehensive and scientific report contents and indicators, and emphasizing the self-evaluation function and self-improvement function of the hospital performance evaluation.
ObjectiveTo analyze the application of visual management in foreign medical service management, and to provide a reference for lean medical management practice in China.MethodsUsing “visual management” and “visual tool” as the search terms, we searched PubMed, Web of Science, Springer Link, ScienceDirect, to retrieve relevant literature on the application of visual management tools to improve medical services in foreign countries. The number of published articles, journals, improvement objectives, measures and effects were analyzed descriptively.ResultsA total of 534 articles were retrieved. According to the inclusion and exclusion criteria, 7 articles were finally included, all of which were published in SCI journals, of which the number of articles in the United States was the highest (5 articles). Among the 7 included articles, 3 articles used face cards, 2 articles used whiteboards, 1 article used electronic Kanban, and 1 article used discharge “traffic lights”. Five articles studied the improvement of doctor-patient communication, and two studied the improvement of bed turnover rate. In the included articles, the contents of visualization mainly include the nursing goals of the inpatient, inspection plan, turnover, discharge plan, and the names and roles of medical staff.ConclusionsVisual management tools have a significant effect on promoting doctor-patient communication and improving hospital bed turnover. The application of foreign visual management tools in wards is relatively mature, and used more in promoting doctor-patient communication. Visual management tools are constantly updated, and electronic tools may gradually become a trend in the future.