缩短脑梗塞住院病人的平均住院日课件.ppt

1、缩短脑梗塞住院病缩短脑梗塞住院病人的平均住院日人的平均住院日浙江省台州医院浙江省台州医院杜于茜杜于茜项目陈述：项目陈述：2003年我院平均住院日为年我院平均住院日为11.72天，其天，其中脑梗塞病人平均住院日为中脑梗塞病人平均住院日为14.58天病人天病人住院费用增加；床位周转率降低；工作人住院费用增加；床位周转率降低；工作人员工作负荷加重；医院收入减少员工作负荷加重；医院收入减少。由此，。由此，医院确定了医院确定了2004年缩短平均住院日年缩短平均住院日1天天的目标。的目标。项目组织：项目组织： 赞助人：赞助人： 陈海啸陈海啸 组长：组长： 杜于茜杜于茜 成员：金笑平，赵俐玲，张丹红成员：金

2、笑平，赵俐玲，张丹红 MBB： 陈媛陈媛项目范围：项目范围： 神经内科神经内科脑梗塞住院病人脑梗塞住院病人 2003.62004.10项目目标：项目目标： 缩短脑梗塞平均住院日缩短脑梗塞平均住院日23天天 提高病人满意度提高病人满意度团队章程团队章程定义定义 事务04.3.243.3104.4.14.704.4.74.1404.4.145.1404.5.159.104.11.10D定义M测量A分析I改善C控制R报告 项目时间表项目时间表治疗治疗病人出院病人出院Y1Y2 Y3Y4辅助检查辅助检查是否确诊是否确诊否疗程结束疗程结束是否缓解是否缓解是否Y5是概括流程图概括流程图病人病人入院入院Y=脑

3、梗塞病人平均住院日Defect=脑梗塞病人住院日1.58天(上限：15.9天）测量测量数据采集表病案病案号号YX1X2X3X4X5X6X7X8X9X10X11X12Y1Y1Y2Y2Y3Y3Y4Y4Y5Y5病程病程入入院院时时病病情情是否是否专病专病专治专治有无有无合并合并症症有无有无并发并发症症沟通沟通次数次数治疗治疗方案方案是否是否医生医生要求要求出院出院是否是否病人病人要求要求出院出院是否保是否保险险主治医主治医师师主管护主管护士士102540557095% Confidence Interval for Mu121314151695% Confidence Interval for Me

4、dianVariable: Y7A-Squared:P-Value:MeanStDevVarianceSkewnessKurtosisNMinimum1st QuartileMedian3rd QuartileMaximum13.2614 7.890512.00007.7800.00014.5789 8.727876.17463.1383816.9265171 4.000010.000013.000017.000077.000015.8965 9.765514.0000Anderson-Darling Normality Test95% Confidence Interval for Mu95

5、% Confidence Interval for Sigma95% Confidence Interval for MedianDescriptive Statistics改进前脑改进前脑梗塞平均梗塞平均住院日为住院日为. 人人 法法 料料主管医师误诊误治家属沟通病房空床率 缩短脑梗塞缩短脑梗塞平均住院日平均住院日机机环环测测首席护士护送队病人专病专治药物治疗方案特殊治疗辅检等待事件检查设备检查项目费用药品病房环境病人家庭条件疗效评价出院标准鱼骨图鱼骨图择日鱼骨图鱼骨图Y4/Y5 为主要改进的小Y0123495% Confidence Interval for Mu0.00.10.295%

6、Confidence Interval for MedianVariable: Y2A-Squared:P-Value:MeanStDevVarianceSkewnessKurtosisNMinimum1st QuartileMedian3rd QuartileMaximum0.014880.506260.0000061.879 0.0000.0994150.5599890.3135885.9291535.25801710.000000.000000.000000.000004.000000.183950.626570.00000Anderson-Darling Normality Test9

7、5% Confidence Interval for Mu95% Confidence Interval for Sigma95% Confidence Interval for MedianDescriptive Statistics0123495% Confidence Interval for Mu0.000.050.1095% Confidence Interval for MedianVariable: Y3A-Squared:P-Value:MeanStDevVarianceSkewnessKurtosisNMinimum1st QuartileMedian3rd Quartile

8、Maximum0.000110.349560.0000061.566 0.0000.0584800.3866540.1495017.9805870.92631710.000000.000000.000000.000004.000000.116850.432630.00000Anderson-Darling Normality Test95% Confidence Interval for Mu95% Confidence Interval for Sigma95% Confidence Interval for MedianDescriptive Statistics0481216202495

9、% Confidence Interval for Mu891095% Confidence Interval for MedianVariable: Y4A-Squared:P-Value:MeanStDevVarianceSkewnessKurtosisNMinimum1st QuartileMedian3rd QuartileMaximum 8.0022 4.5746 9.00002.8880.0008.766085.0600225.60386.97E-020.375530171 0.0000 5.000010.000012.000026.0000 9.5299 5.661610.000

10、0Anderson-Darling Normality Test95% Confidence Interval for Mu95% Confidence Interval for Sigma95% Confidence Interval for MedianDescriptive Statistics010203040506095% Confidence Interval for Mu0.51.52.53.54.55.56.57.595% Confidence Interval for MedianVariable: Y5A-Squared:P-Value:MeanStDevVarianceS

11、kewnessKurtosisNMinimum1st QuartileMedian3rd QuartileMaximum 4.3752 7.6645 1.000013.682 0.0005.654978.4778871.87443.1194415.2224171 0.0000 0.0000 2.0000 9.000063.0000 6.9348 9.4859 4.0000Anderson-Darling Normality Test95% Confidence Interval for Mu95% Confidence Interval for Sigma95% Confidence Inte

12、rval for MedianDescriptive StatisticsY4/Y5为显著因子Regression AnalysisThe regression equation isY = 0.337 + 0.982 Y4 + 0.996 Y5Predictor Coef StDev T PConstant 0.3366 0.1238 2.72 0.007Y4 0.98244 0.01101 89.25 0.000Y5 0.995612 0.006570 151.54 0.000S = 0.7047 R-Sq = 99.4% R-Sq(adj) = 99.3%Analysis of Vari

13、anceSource DF SS MS F PRegression 2 12866.3 6433.1 12953.92 0.000Residual Error 168 83.4 0.5Total 170 12949.7Source DF Seq SSY4 1 1461.5Y5 1 11404.8相关性好150100500806040200I and MR ChartObserv.Mean=14.58UCL=35.67LCL=-6.510706050403020100R=7.929UCL=25.91LCL=015.9 40.5790-11.4211Potential (ST) Capabilit

14、yProcess ToleranceSpecificationsIIIII15.9 40.8230-11.6651Actual (LT) CapabilityProcess ToleranceSpecificationsIIIIIMeanStDevZ.USLZ.LSLZ.BenchZ.ShiftP.USLP.LSLP.TotalYieldPPMCpCpkPpPpkLTSTCapability IndicesData Source:Time Span:Data Trace:0.0543984556.01550.4398450.439845 0.0014 0.1514 0.1514 8.72781

15、4.57890.0543928556.07150.4392850.439285 0.0014 0.1528 0.1528 8.646714.5789Report 2: Process Capability for before改进前的Z值Mood median test for Y4 Chi-Square = 12.78 DF = 6 P = 0.047 Individual 95.0% CIsfangan N Median Q3-Q1 +-+-+-+-A 39 27 10.0 5.0 (-+-)AC 1 2 11.0 5.0 (-+-)AD 17 16 10.0 6.5 (-+-)B 3 1

16、1 11.5 3.2 (+-)BD 4 2 6.5 9.8 (-+-)C 26 10 3.5 12.5 (-+-)CD 7 3 5.5 13.3 (-+-) +-+-+-+- 0.0 5.0 10.0 15.0Overall median = 10.0* NOTE * Levels with 6 observations have confidence 95.0%中晚期康复治疗使住院日明显延长中晚期康复治疗使住院日明显延长治疗方案对Y4有显著影响051015202595% Confidence Intervals for SigmasBartletts TestTest Statistic:

17、8.894P-Value : 0.012Levenes TestTest Statistic: 4.172P-Value : 0.017Factor Levels1234Homogeneity of Variance Test for Y4病人对治疗方案或出院标准不认同影响住院日病人对治疗方案或出院标准不认同影响住院日沟通对Y4有显著影响Mood median test for Y4 Chi-Square = 4.63 DF = 1 P = 0.031 Individual 95.0% CIshebingzh N Median Q3-Q1 -+-+-+-N 14 3 7.00 6.50 (-+

18、-)Y 85 69 10.00 8.00 (-+-) -+-+-+- 6.0 8.0 10.0Overall median = 10.00A 95.0% CI for median(N) - median(Y): (-6.00,0.00)合并症的治疗使住院日明显延长合并症的治疗使住院日明显延长合并症对Y4有显著影响Mood median test for Y4 Chi-Square = 7.32 DF = 1 P = 0.007 Individual 95.0% CIsC23 N Median Q3-Q1 -+-+-+-A 1 0 9.00 Not usedB 29 36 11.00 5.00

19、 (-+-)C 69 36 7.00 7.00 (-+-) -+-+-+- 8.0 10.0 12.0Overall median = 10.00病情严重或病情加重使住院日延长病情严重或病情加重使住院日延长入院病情对Y4有显著影响Mood median test for Y5 Chi-Square = 7.89 DF = 1 P = 0.005 Individual 95.0% CIsyishengy N Median Q3-Q1 +-+-+-+-N 15 3 0.00 0.00 +Y 74 79 3.00 10.00 (-+-) +-+-+-+- 0.0 1.2 2.4 3.6Overall

20、 median = 2.00A 95.0% CI for median(N) - median(Y): (-3.00,-2.00)科内奖金政策可能影响医生对出院时间的决定科内奖金政策可能影响医生对出院时间的决定医生要求出院对Y5有显著影响Mood median test for Y5 Chi-Square = 7.89 DF = 1 P = 0.005 Individual 95.0% CIstiqianch N Median Q3-Q1 +-+-+-+-N 74 79 3.00 10.00 (-+-)Y 15 3 0.00 0.00 + +-+-+-+- 0.0 1.2 2.4 3.6Ove

21、rall median = 2.00A 95.0% CI for median(N) - median(Y): (2.00,3.00)病人对出院标准的不认同可能使住院日延长病人对出院标准的不认同可能使住院日延长病人要求延期出院对Y5有显著影响对Y5影响的X医生要求出院病人要求出院对Y4影响的X合并症入院时病情医患沟通治疗方案医患沟通病人要求出院合并症入院时病情治疗方案医生要求出院 X的矩阵分析的矩阵分析可控不可控重要不重要治疗方案的改进神经内科与康复科联合设立联合卒中单元，分流中晚期康复病人改进改进院科政策 v调整医院与科内政策，考核与平均住院日挂钩v质控部于04.6实施新的质量保证方案，各科

22、室每月质量考核与平均住院日挂钩v科内规定有合并症病人入院3日不能纠正，请相关科室会诊；入院3日诊断不清，科内讨论；科内讨论不能确诊，全院会诊。v医院奖金制度改革，奖金将不再与收入直接挂钩。改进改进 沟通病情变化由首席医生告知，争取病人对出院标准的认同，完成治疗疗程改进改进生命体征稳定发病2周以上一侧肌力恢复超过2级改进改进各医疗组出院标准统一缩短平均住院日 2004年68月脑梗塞平均住院日为11.13天，较2003年缩短3.45天改进后改进后050100010203040I and MR ChartObserv.Mean=11.13UCL=26.36LCL=-4.0960102030R=5.7

23、26UCL=18.71LCL=015.9 -5.6991 27.9622Potential (ST) CapabilityProcess ToleranceSpecificationsIIIII15.9 -4.4742 26.7373Actual (LT) CapabilityProcess ToleranceSpecificationsIIIIIPpkPpCpkCpPPMYieldP.TotalP.LSLP.USLZ.ShiftZ.BenchZ.LSLZ.USLStDevMeanSTLTCapability IndicesData Source:Time Span:Data Trace: 1

24、1.1316 5.5912 0.8529 0.8529 -0.06690.1968710.19687180.31291968710.28 11.1316 5.1842 0.9198 0.9198 -0.06690.1788410.17884182.11591788410.31Report 2: Process Capability for after改进后的Z值改进前后比较Two Sample T-Test and Confidence IntervalTwo sample T for before vs after N Mean StDev SE Meanbefore 171 14.58 8.73 0.67after 114 11.13 5.18 0.4995% CI for mu before - mu after: ( 1.82, 5.07)T-Test mu before = mu after (vs not =): T = 4.18 P = 0.0000 DF = 279有意义潜在收益计算 有形有形每月平均多收个病人年收益66270.94元*12月=451507.68元缩短了平均住院日3.45天减少病人的住院费用 平均住院费7259.54-6514.62744.92元 无形无形提高了住院病人满意度产生了良好的社会效益