目的 通过戴明循环管理法的品管圈（QCC）活动, 提升内镜中心病理标本标识的正确率与病理标本管理安全性。方法 采用基于戴明循环管理法的QCC活动, 对内镜中心病理标本标识质量进行现状把握、原因分析并制定对策, 比较QCC活动开展前后内镜病理标本标识的正确率。结果 QCC活动后, 内镜中心病理标本标识的正确率从99.8%提高至100%（P<0.05）。结论 内镜中心通过开展基于戴明循环管理法的QCC活动, 显著提升了内镜病理标本管理安全性与工作效率。

       Objective To improve the accuracy of pathological specimen identification and the safety of pathological specimen management in endoscopy center through quality control circle（QCC）activity based on Deming cycle management．Methods QCC activity based on Deming cycle management was used to summarize the status quo,analyze the causes and formulate countermeasures for the quality control of pathological specimen identification in endoscopy center．The accuracy rate of endoscopic pathological specimen identification before and after QCC activity was compared．Results After QCC activity, the accuracy of pathological specimen identification in endoscope center increased from 99.8% to 100%．Conclusions QCC activities based on Deming cycle management can greatly improve the safety and efficiency of endoscopic pathological specimen management．

目的 利用品管圈工具提高某三甲医院住院病案首页主要诊断编码正确率。方法 成立品管圈小组,选取2022年11月出院日期前200份住院病案首页作为开展品管圈前的对照组,按照出院科室分层抽取2021年8月1日—2022年3月31日的2 007份首页作为开展品管圈后的研究对象,对上述首页的主要诊断填写及疾病分类编码进行核对、检查、汇总统计。针对主要诊断编码错误率高的现象,从人、法、测3个维度进行分析,根据找出的原因制定对策并执行。根据具体情况使用χ²检验或者四格表资料的Fisher确切概率法检验比较品管圈前后主要诊断编码正确、错误份数的差异。结果 开展一系列改进措施后医生主要诊断填写正确率从95.00%上升到98.01%,编码员主要诊断编码正确率从97.50%上升至99.55%,住院病案首页主要诊断编码正确率从93.50%提高到97.56%,临床医师的书写质量、编码员的编码质量均有改善。品管圈开展前后主要诊断编码正确、错误份数差异有统计学意义。通过开展品管圈,标准化了一个院级规范、多个院级编码共识、两个科级工作工具和机制以及一个科级绩效分配方案。结论 品管圈质量改进工具能有效提高病案首页主要诊断编码正确率,后期应持续开展。

Objective To improve the accuracy of main diagnostic codes on the home page of inpatient medical records in a Class III Grade A Hospital by using the quality control circle．Methods The Medical Record Department set up a quality control circle group．A total of 200 inpatient medical records' home pages were selected as the control group before the quality control circle carried out,which patients were discharged in November 2022．Home pages of 2 007 inpatient medical records from August 1,2021 to March 31,2022 were selected according the discharge department as the research objects after the quality control circle carried out．The main diagnosis filling and disease classification codes on those home pages of the above medical records were checked and summarized．We analyzed the reason of the high error rate of the main diagnostic codes from three dimensions of people,law and test．Countermeasures were formulated and implemented according to the identified causes．Fisher exact probability method of four grid data or χ² test were used to compare the correct copies of main diagnostic codes before and after the quality control circle according to the specific situation．Results The writing quality of clinicians and the coding quality of coders were improved after a series of improvement measures were carried out．The correct rate of doctors' main diagnostic codes increased from 95.00% to 98.01%,the correct rate of coders' main diagnostic codes increased from 97.50% to 99.55%,and the correct rate of main diagnostic codes on the home page of inpatient medical records increased from 93.50% to 97.56%．The number of correct copies of main diagnostic codes before and after the development of the quality control circle was statistically significant．Through the development of the quality control circle,one institute level specification,multiple institute level coding consensus,two department level work tools and mechanisms,and one department level performance allocation scheme have been standardized．Conclusions The application of the quality control circle tool can effectively improve the accuracy of the main diagnostic codes on the home page of the inpatient medical record,which should be continued in the later period．

目的 探究冠心病患者实施血清胆红素与尿酸检验的临床诊断价值。方法 遴选时段2020年6月—2021年6月内100例冠心病患者记观察组,另择取同时段健康体检对象100例记对照组,检测血清胆红素、尿酸水平并2组相对比,同时观察组患者根据冠脉狭窄程度(Gensini法)分组为A、B、C、D组,比较冠脉不同狭窄程度分级下上述指标的变化;评估对比血清胆红素、尿酸单项指标检验与联合检验对冠心病患者的诊断效能。结果 观察组较对照组血清胆红素(总胆红素、直接胆红素、间接胆红素)水平更低,尿酸水平更高,对比有统计学差异(P＜0.05);随着冠脉狭窄程度越严重患者血清胆红素水平呈下降趋势,尿酸水平呈升高趋势,且4组组间比较均差异有统计学意义(P＜0.05);冠心病患者血清胆红素联合尿酸检验的诊断敏感度96.00%、特异度95.00%均高于单项检验敏感度及特异度(P＜0.05)。结论 血清胆红素与尿酸水平可作为冠心病患者诊断的敏感性指标,其与冠心病的发生及发展密切相关,可反映患者病情严重程度,且联合检验诊断价值更高。

Objective To explore the clinical diagnostic value of serum bilirubin and uric acid detection in patients with coronary heart disease. Methods A total of 100 patients with coronary heart disease from June 2020 to June 2021 were selected as the observation group, and another 100 healthy subjects in the same period were selected as control group. Serum bilirubin and uric acid levels were detected and compared between the two groups. Meanwhile, the patients in the observation group were divided into groups A, B, C and D according to the degree of coronary artery stenosis (Gensini method). The changes of the above indexes were compared among different grades of coronary stenosis. And the diagnostic efficacy of each single detection and combined detection of serum bilirubin and uric acid in patients with coronary heart disease were evaluated and compared. Results Compared with the control group, the serum bilirubin (total bilirubin, direct bilirubin, indirect bilirubin) level of the observation group was lower, and the uric acid level was higher, with statistical differences (P<0.05). With the increased severity of coronary artery stenosis, the serum bilirubin level of patients showed a downward trend, while the uric acid level showed an upward trend, and there were significant differences among the four groups (P<0.05). The sensitivity and specificity of serum bilirubin combined with uric acid detection in patients with coronary heart disease were 96.00% and 95.00% respectively, which were higher than those of single detection (P<0.05). Conclusions Serum bilirubin and uric acid levels can be used as sensitive indicators in the diagnosis of patients with coronary heart disease, and are closely related to the occurrence and development of coronary heart disease, which can reflect the severity of the disease, also the diagnostic value of combined detection is higher.

目的 探寻病案首页国际疾病分类(ICD)编码的准确率对按疾病诊断相关分组(DRGs)分值付费影响。方法 整体抽取2019年心血管内科和脊柱关节外科医保病例,分析DRGs分值付费存在的问题,对全院病案首页ICD编码采取相应的干预措施。结果 2019年病案首页ICD编码准确率为81.55%,DRGs分值付费亏损2 812 804.7元,经干预后,2020年病案首页ICD编码准确率为97.13%,DRGs分值付费结余14 089 039.36元。结论 准确、规范的填写病案首页ICD编码,提高病案首页ICD编码的准确率,避免医院在DRGs分值付费模式下出现亏损有重要意义。

Objective To investigate the influence of the front page International Classification of Diseases(ICD) coding accuracy of medical records on diagnosis related groups(DRGs) score payment system.Methods Medical insurance cases of cardiovascular medicine and spine and joint surgery in 2019 were totally selected,the problems of DRGs score payment system were investigated and analyzed,and managements improving the ICD coding on the medical records of discharged patients were carried out.Results In 2019,the accuracy of ICD coding of medical records was 81.55%,and the DRGs score payment system had lost 2 812 804.7 yuan.After improving,in 2020,the ICD coding accuracy achieved 97.13%,and DRGs score payment system had a positive balance of 14 089 039.36 yuan.Conclusions The accuracy and standardization of ICD coding on the medical records is of great significance in avoiding losses on DRGs score payment system.

目的 探讨循证护理干预在肺功能检查中对检查准确性的影响。方法 选取行肺功能检查患者80例,随机分为2组,分别记录为观察组40例和对照组40例,分别实施循证护理干预和常规护理干预,比较两组患者肺功能检查时间、肺功能检查结果及护理满意度。结果 观察组患者平均肺功能检查时间短于对照组(P<0.05);观察组患者肺功能检查正常率高于对照组;且观察组患者对护理服务的满意度高于对照组,组间对比差异有统计学意义(P<0.05)。结论 对行肺功能检查的患者实施循证护理干预效果显著,有利于缩短患者肺功能检查时间,并可提高检查的准确率,且有利于改善护患关系,值得在临床上推广应用。

Objective To investigate the influence of evidence-based nursing intervention on the accuracy of the examination in pulmonary function test. Methods 80 cases of patients with lung function examination, were randomly divided into 2 groups, were recorded in 40 cases of observation group and control group 40 cases, respectively. The implementation of evidence-based nursing intervention and routine nursing intervention were taken, to compare times of patients with pulmonary function test, pulmonary function test results and nursing satisfaction in two groups. Results In the observation group the average lung function examination time was shorter than that of the control group (P<0.05); normal pulmonary function tests was higher than that of the control group; satisfaction with nursing service was higher than the control group, there was statistical significance the differences between the two groups (P<0.05). Conclusion The pulmonary function test for patients with the implementation of evidence-based nursing intervention has significant effect. It can shorten the time in patients with pulmonary function examination, improve the inspection accuracy, and improve the relationship between nurses and patients, it is worthy of clinical application.