目的 分析广州某三甲医院脑梗死患者住院费用的变化以及影响因素,为有效减轻患者疾病经济负担提供参考依据。方法 提取广州某三甲医院2015—2022年出院诊断ICD-10前三位编码为I63的病案首页数据,并采用IBM SPSS 20.0软件对费用结构进行描述性统计分析,以多重线性回归分析患者住院费用的影响因素。结果 2015—2022年脑梗死患者的平均住院费用年均增长率为2.86%;费用结构以药品费为主,占比逐年下降,至2022年占比为27.74%,技术劳务性费用占比逐年增加,至2022年占比为47.41%;住院费用主要受医院感染情况、住院天数以及支付方式等因素影响（F=990.10,P<0.001）。结论 脑梗死患者的住院费用结构显著优化,但患者的疾病经济负担仍然较重,且费用受多种因素的综合影响。建议通过提高医疗质量与服务效能,并严格落实临床路径管理,减少不必要的检查以及耗材使用,以期最大程度地减轻患者的负担。

Objective To analyze the structural changes and influencing factors of the hospitalization expenses for patients with cerebral infarction in a tertiary general hospital in Guangzhou,and provide a scientific basis for reducing economic burden of the patients．Methods The front page data of medical records with the main diagnosis of I63 were collected in the sample hospital．Descriptive statistics analysis of hospitalization expenses structure and multiple linear regression analysis of the influencing factors were carried out by SPSS 20.0．Results The annual growth rate of average hospitalization expenses of cerebral infarction patients from 2015 to 2022 in the sample hospital was 2.86% per year．The highest proportion of hospitalization expenses was medicine fee,the proportion of which declined year by year with a minimum 27.74% in 2022．The proportion of technical labor costs accelerated year by year with a maximum 47.41% in 2022．This study revealed the main factors influencing hospitalization expenses were hospital internal infection or not,length of stay,payment method and so on（F=990.10,P<0.001）．Conclusions The structure of hospitalization expenses for cerebral infarction patients was significantly optimized,but the economic burden of patients was still heavy affected by a combination of factors．In order to minimize the burden of patients,hospitals should improve medical quality and service efficiency and implement clinical pathway management strictly,to reduce unnecessary inspections and consumables．

目的 分析医院门诊西药房“分-全带教”模式的应用效果,为提高药房实习生的教学质量提供参考价值。方法 选取广州市番禺区中心医院药学部门诊西药房2020年9月—2022年7月的48例实习生（包含进修生、研究生）作为研究对象,对所有实习生实施“分阶段、分层级、分诊断单元窗口学习、全面能力培养”的“分-全带教”模式。观察所有实习生入科实习前后的考核成绩。结果 通过“分-全带教”实施后,实习生的理论知识（94.15±3.38）分、药学服务技能评分（90.56±3.99）分均比实习前有所提升,且实习生的学习兴趣（94.21±3.70）分、巩固知识点（91.98±3.56）分、提高医患沟通（92.73±3.81）分、认识自身技能不足（92.06±3.50）分同时提升（P<0.05）。结论 采用“分-全带教”模式明显提升对医院门诊西药房的实习生中的教学效果,实习生的理论和实践技能均有所提高,其药学服务能力同时得到提高。

Objective To analyze the application effectiveness of the “divided-comprehensive precepting” model in the hospital outpatient pharmacy and provide reference value for improving the teaching quality of pharmacy interns．Methods Forty-eight interns（including visiting scholars and graduate students）from the Pharmacy Department of Panyu Central Hospital in Guangzhou,China,from September 2020 to July 2022 were selected as the research subjects．The “divided-comprehensive precepting” model,characterized by “staged,tiered,diagnosis unit-specific window learning,and comprehensive competency development” was implemented for all interns．The scores of all interns before and after entering the internship were observed．Results After the implementation of the“divided-comprehensive precepting”model,the scores of interns in theoretical knowledge（94.15±3.38）and pharmaceutical service skills（90.56±3.99）were improved compared to those before the internship．Moreover,interns’scores in learning interest（94.21±3.70）,consolidating knowledge（91.98±3.56）,enhancing doctor-patient communication（92.73±3.81）and recognizing their own skill deficiencies（92.06±3.50）were also improved．Conclusions The “divided-comprehensive precepting” precepting model significantly enhances the teaching effectiveness in the internship of hospital outpatient pharmacy．Interns’ theoretical and practical skills are improved,enhancing their pharmaceutical service capabilities．

价值医疗下公立医院需转变运营管理模式,建设专门运营管理部门对满足外部政策要求和改善内部运营管理十分必要。通过梳理公立医院开展运营管理的主要任务,确定公立医院专门运营管理部门的职责,设计与承担职责相适应的组织架构,保证专门运营管理部门的职能充分发挥。

Public hospitals need to change the operation management mode under value-based healthcare．It is necessary to build a special operation management department to meet the requirements of external policies and improve internal operation management．By sorting out the operation and management tasks of public hospitals,the responsibilities of the operation management department are determined,and the organizational structure suitable for the responsibilities is designed,so that the construction of specialized operation management department can be effectively implemented．

目的 分析PDCA管理法在医院药事管理中的应用效果。方法 将我院2 000批药品设置为研究对象,样本纳入的起始、截止时间分别为2022年1月、2022年12月,依据时间对纳入样本开展组别划分,将2022年1月—6月1 000批药品设置为PDCA管理前研究对象,期间接受常规药品管理;将2022年7月—12月1 000批药品设置为PDCA循环法管理后研究对象。对比PDCA管理前后药品不良事件发生率及药事管理质量评分。结果 PDCA循环法管理后药学差错事件发生率低于PDCA循环法管理前,分别为0.30%、1.90%,对比差异有统计学意义（P<0.05）;PDCA循环法管理后建立药品质量监控体系、药品调剂制度、抗肿瘤药物分级管理方案和处方管理、临床药师参与四个维度评分较PDCA循环法管理前均有明显提升,分别为18.15±1.83、18.15±1.64、18.22±1.67、18.07±1.84,管理前后评分对比差异具有统计学意义（P<0.05）。结论 医院药事管理采用PDCA管理法可提升药事管理质量,降低药品不良事件发生率,值得应用。

Objective To analyze the application effect of PDCA cycle method in hospital pharmaceutical management．Methods A total of 2 000 batches of drugs in our hospital were included as research objects,the inclusion start and end of samples were January 2022 and December 2022．The included samples were divided into groups according to the time,1 000 batches of drugs from January 2022 to June 2022 were included as research objects before PDCA management,during which they were subjected to routine drug management．1 000 batches of drugs from July 2022 to December 2022 were included as the research objects under management by PDCA cycle method．The incidence of adverse drug events and the quality score of drug administration before and after PDCA administration were compared．Results The incidence of pharmaceutical error events after PDCA cycle management was lower than that before PDCA cycle management,which were 0.30% and 1.90%,respectively,and the differences were statistically significant（P<0.05）．After PDCA cycle management,the scores of establishment of drug quality control system（18.15±1.83）,drug dispensing system（18.15±1.64）,anti-tumor drug grading management scheme and prescription management（18.22±1.67）,clinical pharmacist participation（18.07±1.84）were significantly improved compared with those before PDCA cycle management,and the difference between scores before and after PDCA cycle management was statistically significant（P<0.05）．Conclusions PDCA cycle can improve the quality of pharmaceutical management and reduce the incidence of adverse drug events,which is worthy of application．

在“放管服”改革的背景下,基于业财融合管理理念对医院科研物资进行一体化管理是发展趋势。但由于科研项目管理涉及众多部门,流程繁杂,致使医院科研物资管理面临诸多问题。为了改变现状,广州市某三甲医院探索构建基于业财融合的医院科研物资一体化信息系统,分别上线了科研物资采购平台和经费管理系统,并在实践中对信息系统进行了优化与设计。实践证明,该系统具有创新性和应用价值,对医院的财务管理和科研项目管理具有重要的参考意义。

Under the background of streamlining administration and delegating power,the integrated management of hospital scientific research materials based on the concept of integrating industry and finance is a development trend．However,due to the involvement of multiple departments and complicated processes in scientific research project management,the management of hospital scientific research materials faces many problems．In order to change the current situation,a Tertiary Grade A Hospital in Guangzhou explored the construction of an integrated information system for hospital scientific research materials based on the integration of industry and finance．They launched a scientific research material procurement platform and a funding management system,and optimized and designed the information system in practice．Practice has proven that the system is innovative and valuable,and it has important reference significance for the financial management and scientific research project management of hospitals．

伴随着对医疗领域人才水平要求的逐步提高,医院人力资源管理尤其是医院人才引进工作正在由规模化发展向精细化发展转变。当前医院人才引进过程中存在缺乏人力资源发展规划、高层次人才引进方法有待完善、人才管理能力亟须提高、科室用人需求脱离实际、忽视对于岗位胜任力的分析等问题。人力资源成熟度模型（People Capability Maturity Model,P-CMM）作为一种系统的管理理论,其具备很强的实践性,文章对人力资源成熟度模型在医院人才引进工作中的本土化应用进行相关讨论与研究,将P-CMM不同成熟度等级、过程域目标与医院人才引进工作相结合,并提出可操作性指导,具有一定的理论与实践价值。

With the gradual improvement of the requirements for talents in the medical field,hospital human resource management,especially the introduction of talents in hospitals,is changing from large-scale development to refined development．At present,there are some problems in the process of hospital talent introduction,such as lack of human resource development plan,improvement of high-level talent introduction method,improvement of talent management ability,separation of department employment demand from reality,neglect of post competency analysis,etc．People Capability Maturity Model（P-CMM）,as a systematic management idea,has strong practicality．This study discusses and studies the localization application of human resource maturity model in hospital talent introduction,combines different maturity levels and process area objectives of P-CMM with hospital talent introduction,and puts forward operational guidance It has certain theoretical and practical value．

随着新医改全面深化、医保基金支付方式改革、国家公立医院绩效考核持续推进等新业态,医院靠粗放式规模扩张的收入模式不再适应新时期的发展。大多数基层公立医院不重视运营管理,存在收不抵支的财务风险与压力,导致医院面临巨大的良性运营挑战。探究基层公立医院的运营管理现状,普遍存在运营定位不清晰、运营组织体系不完善、运营意识薄弱、业财融合理念不强、专业人才少、信息系统功能不完善等诸多问题。如何有效应对潜在运营风险,推动转变管理模式并向高质量发展成为基层公立医院面临的重要课题。为此,基层公立医院迫切需要加强运营管理,对人、财、物、技术、空间等核心资源进行评估和流程管理,多管齐下,提高运营效率和社会经济效益,实现向管理要效益,解决收不抵支问题,推动医院可持续和高质量发展。

目的 探讨专项调查重点科室医务人员手卫生依从性及知识知晓情况结合院感信息系统在降低医院感染中的应用效果。方法 选取2018年1月—2020年12月本院重点科室收治的患者527例,根据入院时间进行分组,对照组采取常规院感管理,观察组采取基于院感信息系统的管理方式,并对重点科室的100名医务人员手卫生依从性及相关知识知晓情况进行专项调查,比较2组医务人员手卫生依从性、手卫生知识知晓程度及医院感染率的差异。结果 观察组医务人员执行各项操作的手卫生依从性、手卫生知识评分均高于对照组(P<0.05);观察组患者医院感染率低于对照组(P<0.05)。结论 采用专项调查重点科室医务人员手卫生依从性及知识知晓结合院感信息系统,能有效提高医务人员的手卫生依从性及相关知识知晓程度,降低医院感染的发生风险。

Objective To discuss the effect of applying special investigation on the hand hygiene compliance and knowledge of medical staff in key departments combined with nosocomial infection information system in reducing nosocomial infections. Methods A total of 527 patients admitted to the key departments from January 2018 to December 2020 were selected, and were grouped according to the time of admission.The control group received routine nosocomial infection management, and the observation group received the management based on nosocomial infection information system.A special survey of hand hygiene compliance and related knowledge was carried out on 100 medical staff in those department, and the differences in hand hygiene compliance, hand hygiene knowledge and nosocomial infection rates between the two groups were compared. Results The hand hygiene compliance and hand hygiene knowledge scores of the medical staff in the observation group were significantly higher than those in the control group (P<0.05). The infection rate of observation patients was lower than control patients (P<0.05). Conclusions The use of special survey on hand hygiene compliance and knowledge of medical staff in key departments combined with nosocomial infection information systems can effectively improve medical staff's hand hygiene compliance and related knowledge, reduce the risk of nosocomial infections, which is worthy of promotion.

目的 了解急诊科综合病区患者疾病分类构成的特点,为护士进行有针对性的培训,并为合理调配护理人员提供依据。方法 对2020年1月—2021年12月我院急诊科综合病区收治的1 901例患者疾病分类、收治时间等进行回顾性调查分析。结果 研究期间急诊综合病区共收治患者1 901例,收治患者以呼吸系统的患者居多,占比47.71%;以循环系统疾病的患者平均发病年龄最高,为(66.434±11.691)岁;全年各月以1月、12月收治病人居多。结论 根据调查分析,有针对性地对护士进行呼吸系统疾病护理技能培训,并在收治高峰期,合理调配护理人员,实施弹性排班,保障患者安全,提高护理质量。

Objective To understand the characteristics of disease classification and composition of patients in Comprehensive Ward of Emergency Department, provide targeted training for nurses, and provide basis for rational deployment of nursing staff. Methods A total of 1 901 patients in the Comprehensive Ward of Emergency Department of our hospital from January 2020 to December 2021 were investigated and analyzed retrospectively according to different diseases and time of admission. Results A total of 1 901 patients were treated in the Emergency Comprehensive Ward during the study period. Most of the patients were with respiratory system disease, accounting for 47.71%. The average onset age of patients with circulatory diseases was the oldest, which was (66.434±11.691). Most patients were admitted in January and December. Conclusions According to the investigation and analysis, nurses should be trained with the skills of respiratory diseases nursing, nursing staff should be reasonably allocated and flexible shift should be scheduled during the peak period of admission, so as to ensure the safety of patients and improve the quality of nursing.

目的 探讨医院消毒供应中心清洗全程质量控制用于院内感染风险预防价值。方法 选取2019年1月—2021年6月期间医院消毒供应中心待清洗消毒的1 000件手术器械（观察组）,采用全程质量控制;另选取1 000件手术器械（对照组）,常规流程清洗;比较2组患者器械清洗质量,统计清洗后因术中器械的院内感染率。结果 观察组清洗消毒后器械血渍、污垢、锈斑总发生率0.20%,低于对照组的1.50%,器械清洗、消毒、灭菌合格率高于对照组（P<0.05）。观察组器械操作流程与标准、科室管理、安全管理、综合质量管理高于对照组,院内感染率0.10%低于对照组的1.00%,医护人员满意度95.00%高于对照组的75.00%（P<0.05）。结论 医院消毒供应中心清洗质量控制,可增加手术器械清洗质量,减少院内感染的发生。

Objective To explore the value of whole process cleaning quality control in hospital disinfection supply center for risk prevention of hospital infection．Methods From January 2019 to June 2021,1000 surgical instruments to be cleaned and disinfected in the hospital disinfection supply center（observation group）were selected,and the whole process quality control was applied;another 1000 surgical instruments（control group）were selected for routine cleaning．The quality of instrument cleaning in the two groups was compared,and the hospital infection rate after the application of cleaned instrument was calculated．Results After cleaning and disinfecting instruments,the total incidence of blood stains,dirt and rust was 0.20% in the observation group,lower than that in the control group,which was 1.50%,and the qualified rate of instrument cleaning,disinfecting and sterilizing was higher than that in the control group（P<0.05）．The equipment operation procedures and standards,department management,safety management,and comprehensive quality management of the observation group were higher than those of the control group,the hospital infection rate was 0.10%,lower than that of the control group（1.00%）,and the satisfaction rate of medical staff was 95.00% in the observation group,higher than that of the control group（75.00%,P<0.05）．Conclusions The cleaning quality control of hospital disinfection supply center can improve the cleaning quality of surgical instruments and reduce the occurrence of hospital infection.