摘要
目的分析某院非医嘱离院患者相关特征及影响因素,为优化医院管理和提升医疗质量提供依据。方法调取山东省某三甲医院2018年1月1日-12月31日出院患者数据67 563例,应用多因素logistic回归分析患者非医嘱离院的影响因素。结果 67 563例出院患者中,医嘱离院59 925例,非医嘱离院6799例,非医嘱离院率为10.06%。有手术操作(OR=12.842)、有抢救(OR=3.260)、全自费(OR=1.534)、外埠患者(OR=1.265)、入院病情不确定(OR=1.297)是影响患者非医嘱离院的主要因素。非医嘱离院内科例数最多为1936,占28.47%,其次为儿科、外科;重症医学科非医嘱离院率最高为69.86%,其次为急诊科、内科。非医嘱离院前三位病种为肿瘤、损伤及中毒和神经系统疾病。结论非医嘱离院是多种因素综合作用的结果,应采取针对性措施降低非医嘱离院率,如提高诊断效率和水平、提升急危重症的救治能力、加强围手术期管理、强化医患沟通训练、简化就医流程、改善住院环境等,此外相关部门也应落实好双向转诊和异地医保结算政策。
Objective Through analyzing on the related factors of discharged inpatients without doctor’s advice,to provide basis for optimizing hospital management and improving medical quality.Method Based on the data of discharged patients from a Three-level A-rate hospital in western Shandong from January 1 to December 31,2018.Multivariate logistic regression analysis was applied to analyze the main factors affecting patients’without doctor’s advice to leave hospital.Results Amongthe 67563 discharged patients,59925 patients were ordered out of hospital,6799 were non ordered out of hospital,and the rate of non-doctor-advicedischarged hospital was 10.06%.The main risk factors weresurrical operation(OR=12.842),rescue(OR=3.260),full self expense(OR=1.534),patients from other places(OR=1.265)and uncertain condition of admission(OR=1.297).The highest number of medical cases leaving hospital without medical advice was 1936,accounting for 28.47%,followed by pediatrics and surgery.The highest discharged rate was 69.86%,followed by emergency department and internal medicine department.The first three diseases were tumor,injury,poisoning and nervous system diseases.Conclusion Non doctor’s advice leaving hospital is the result of multiple factors.Targeted measures should be taken to reduce the rate,such as improving the efficiency and level of diagnosis,improving the treatment ability of critical illness,strengthening perioperative period management,strengthening the communication training between doctors and patients,simplifying the medical treatment process,improving the inpatient environment,etc.In addition,relevant departments should also implement the two-way referral and remote medical insurance settlement policies.
作者
宋宪锟
范晓棠
贾友波
王献强
戴宝玲
Song Xiankun;Fan Xiaotang;Jia Youbo;Wang Xianqiang;Dai Baoling(The Second People’s Hospital of Liaocheng,The Second Hospital of Liaocheng Affiliated to Shandong First Medical University,Linqing 252601,Shandong Province,China;不详)
出处
《中国病案》
2020年第6期55-57,共3页
Chinese Medical Record
关键词
非医嘱离院
医嘱离院
影响因素
住院患者
Discharged without doctor’s advice
Discharged from hospital
Influencing factors
Hospitalized patients
