某传染病医院临床危急值管理现状与优化策略探讨

Discussion on the Status Quo and Optimization Strategy of Clinical Critical Value Management in an Infectious Disease Hospital

摘要: 目的：通过对该院检验危急值进行统计分析，以发现存在的不足，并针对存在的问题进行分析，为进一步规范管理危急值提供科学依据。方法：回顾性分析该医院各临床科室危急值的发生率、科室分布、项目危急值发生率、危急值通报及时率和周转时间以及无菌部位标本培养微生物构成及阳性菌种占比情况。结果：危急值上报主要集中在感染科和内科。危急值5年平均发生率为1.51%，同一年内各科室之间危急值发生率差异有统计学意义(P < 0.05)。5年内，各科室危急值发生率除精神四科及其他科室(中医科、内科门诊、康复科)差异无统计学意义(P > 0.05)外，其余科室均有统计学差异(P < 0.05)且感染科、内科、外科、感染科门诊、呼吸科、结核科的危急值发生率在5年间呈现趋势变化。危急值发生率排名前五的项目依次为：无菌部位标本培养(10.23%)、二氧化碳分压(7.06%)、超敏肌钙蛋白T (6.40%)、酸碱度(5.43%)和氧分压(3.57%)，各项目危急值发生率除凝血酶原时间、血清钠离子、氯离子和尿素差异无统计学意义(P > 0.05)外，其余项目均有统计学差异(P < 0.05)。各项目危急值通报及时率范围为96.71%~99.60%；周转时间的中位数(P₅₀)控制较好，但第75百分位数(P₇₅)和第90百分位数(P₉₀)控制不理想。无菌部位标本培养微生物阳性率为10.25%，其中阳性菌种以丝状真菌为主(51.41%)，其次为酵母样真菌(16.62%)和革兰阳性杆菌(16.24%)。结论：为更加规范地为患者提供安全、有效、及时的诊疗服务，应定期对危急值的记录、上报及管理情况进行分析总结，以发现存在的不足，及时整改，并追踪整改效果，采取有效措施确保整改落实，以持续改进医疗质量。

Abstract: Objective: Through the statistical analysis of the hospital’s test critical value, to find out the existence of deficiencies, and to analyze the existing problems, to further standardize the management of critical value to provide a scientific basis. Methods: Retrospectively analyze the incidence rate of critical values in each clinical department of the hospital, departmental distribution, the incidence rate of project critical values, the timely rate of critical value notification and turnaround time, as well as the microbial composition of culture of specimens in the sterile site and the percentage of positive bacterial species. Results: Critical value reporting was mainly concentrated in the departments of infection and internal medicine. The 5-year average incidence rate of critical values was 1.51%, and the difference in the incidence rate among departments within the same year was statistically significant (P < 0.05). In the 5 years, the incidence rate of critical values in each department was statistically different (P < 0.05) except for the psychiatric department of the fourth department and the other departments (traditional Chinese medicine, internal medicine clinic, and rehabilitation), and there were statistically differences among the other departments (P < 0.05) and the infectious disease department, internal medicine, surgery, infectious disease clinic, internal medicine clinic, and rehabilitation. There was no statistically significant difference (P > 0.05) in the other departments, except for the departments of internal medicine, surgery, outpatient infectious diseases, respiratory disease, and tuberculosis. The top five items in order of incidence of critical values were: culture of sterile site specimens (10.23%), partial pressure of carbon dioxide (7.06%), ultrasensitive troponin T (6.40%), acidity and alkalinity (5.43%), and partial pressure of oxygen (3.57%), and there was no statistically significant difference in the incidence of critical values of the items except for the prothrombin time, serum sodium ions, chloride ions, and urea (P > 0.05). Except for prothrombin time, serum sodium ion, chloride ion and urea, there was a statistically significant difference in the remaining items (P < 0.05). The range of timeliness of critical value notification for each item was 96.71% to 99.60%; the median turnaround time (P₅₀) was well controlled, but the 75th percentile (P₇₅) and 90th percentile (P₉₀) were not well controlled. The culture microbial positivity rate of sterile site specimens was 10.25%, with filamentous fungi dominating the positive species (51.41%), followed by yeast-like fungi (16.62%) and gram-positive bacilli (16.24%). Conclusion: To provide safe, effective and timely diagnosis and treatment services for patients in a more standardized way, the recording, reporting and management of critical value should be analyzed and summarized regularly to find out the deficiencies, rectify them in time, track the effect of rectification, and take effective measures to ensure the implementation of rectification to improve the quality of medical care sustainably.