造口治疗师主导多学科合作伤口处理风险管理的实施与效果
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戴薇薇, Email: 1163956773@qq.com

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中南大学湘雅医院管理研究基金资助项目(2016G209)。


Multidisciplinary collaboration led by enterostomal therapists for risk management of wound treatment: implementation  and results
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    摘要:

    目的:探讨造口治疗师(ET)主导多学科合作伤口处理风险管理的实践与效果。
    方法:收集2013年5月—2017年4月4年来湘雅医院伤口中心接诊的患者资料,从2015年5月开始,接诊的患者均采用ET主导多学科合作的伤口处理风险管理流程,包括:风险评估、风险分析、风险识别与风险决策,将确认有治疗和操作难度、潜在纠纷的患者作为风险管理重点对象,联动多学科合作团队,采取一系列风险防控措施。比较该流程实施前后的患者人数、结构、来源及患者满意率、不良事件发生率。
    结果:与实施前比较,实施后的接诊患者总例次增加27.74%,医生转诊例次增加54.76%,慢性伤口例次增加51.34%,病房会诊例次增加52.63%;实施后不良事件发生率较实施前明显降低(0.05% vs. 0.12%,P<0.05),实施后患者满意率较实施前明显提高[(95.36±0.52)% vs.(90.34±0.45)%,P<0.05]。
    结论:ET主导多学科合作的伤口处理风险管理有助于降低患者不良事件发生率,提高患者满意率,提升伤口处理水平,推荐临床采用。

    Abstract:

    Objective: To investigate the implementation of multidisciplinary collaboration led by enterostomal therapists (ET) for risk management of wound treatment and the effect.  
    Methods: The data of all patients attending the Center of Wound Care of Xiangya Hospital from May 2013 to April 2017 were collected. The process of multidisciplinary collaboration led by ET for risk management of wound treatment was implemented in patients admitted since May 2015, which included risk assessment, risk analysis, risk identification, and risk decision, and in those regarded as important individuals due to obvious treatment and operative difficulties or potential medical disputes, a series of risk prevention and control measures were performed in partnership with multidisciplinary team. The number, constitution and source of patients as well as patients’ satisfaction rate, and incidence of adverse events were compared before and after implementation of the process.
    Results: After implementation, the total number of admitted patients increased by 27.74%, the number of referrals from doctors increased by 54.76%, the number of patients with chronic wounds increased by 51.34%, and the number of ward consultations increased by 52.63% compared with those before implementation. The incidence of adverse events was significantly reduced (0.05% vs. 0.12%, P<0.05) and the patients’ satisfaction rate was significantly increased [(95.36±0.52) % vs. (90.34±0.45) %, P<0.05] after implementation comparted with those before implementation. 
    Conclusion: Implementation of multidisciplinary collaboration led by ET for risk management of wound treatment can reduce the incidence of adverse events, increase the patients’ satisfaction rate and improve the wound treatment efficacy. So, it is recommended to be used in clinical practice.

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张其健, 戴薇薇, 贺爱兰, 唐琼芳, 田含章, 周秋红.造口治疗师主导多学科合作伤口处理风险管理的实施与效果[J].中国普通外科杂志,2019,28(2):212-218.
DOI:10.7659/j. issn.1005-6947.2019.02.012

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  • 收稿日期:2018-10-22
  • 最后修改日期:2019-01-17
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  • 在线发布日期: 2019-02-25