With the rapid development of information technology, medical reforms in various countries are moving towards informatization, and internet medical projects have been carried out gradually. Internet hospitals, as one of the manifestations of internet medical projects, have the advantages of improving the efficiency of medical services, revitalizing and effectively sinking high-quality medical resources, and therefore has become the focus of China’s next stage of medical reform. However, internet hospitals are innovative and local products of China, leading its practices lack of domestic and foreign theoretical research, as well as experience, which results in government policies and hospital management strategies are both moving forward in groping, and the construction outcomes vary. Therefore, this article aims to analyze the comprehensive dilemmas currently confronted by internet hospitals in China in different stages of construction, operation and management based on PDCA cycle, and thus, puts forward corresponding construction thinking and analysis in a targeted manner, and proposes guidance for the further development of internet hospitals.
Objective To analyze the main problem of continuous hand hygiene improvement by PDCA cycle, find out the causes and carry out corresponding measures, in order to improve hand hygiene management continuously. Methods Between January and June 2014, PDCA cycle was used to strengthen comprehensive training, enhance awareness of hand hygiene, reinforce supervision, and evaluate the effect of continuous hand hygiene improvement. The knowledge of hand hygiene, increase of hand hygiene facilities, use of hand hygiene products and hand hygiene implementation before (from July to December 2013) and after PDCA application (from January to June 2014) were compared and analyzed. Results After the implementation of PDCA cycle, the pass rate of hand hygiene knowledge increased from 61.0% to 88.3%; the total amount of hand hygiene use increased from 1 817 046 mL to 3 347 386 mL; the hand hygiene compliance rate increased from 43.03% to 71.31%; and the correct rate of hand hygiene implementation increased from 62.68% to 87.68%. All the above differences were statistically significant (P<0.05). After the implementation of PDCA cycle, the compliance rate of different hand hygiene indications became significantly different (P<0.05). The growth rate of hand hygiene implementation before aseptic manipulation and after contact with body fluids were relatively higher (34.56% and 34.01%, respectively). Conclusion Through the application of PDCA cycle, hand hygiene compliance rate and correct rate have gradually increased.
ObjectiveTo analyze the effectiveness of PDCA cycle model in antibiotics management by comparison of antibiotics use before and after the use of PDCA in a tertiary hospital. MethodsProspective study was adopted to analyze the using rate of antibiotics in outpatients, emergent patients and inpatients between June 2011 and December 2013. ResultsThe reasonable antibiotics use was improved since the beginning of PDCA cycle model. The antibiotics using rates of outpatients were 33.00%, 29.09% and 19.31%, of emergent patients were 45.00%, 32.81% and 28.94%, and of inpatients were 71.00%, 57.76% and 53.28% in year 2011 (from June to December), 2012 (from January to December) and 2013 (from January to December) respectively. Meanwhile, ClassⅠ incision antimicrobial use also decreased and bacteria examination rate continuously increased during the last three years. As a consequence, patients' cost was reduced. ConclusionThe PDCA cycle model promotes the standardized management of clinical medication application.
Objective To explore the clinical effect of failure mode and effect analysis (FMEA) combined with PDCA cycle management model in the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), and provide evidences for drawing up improvement measures in healthcare-associated MDRO infections in ICU. Methods In January 2020, a risk assessment team was established in the Department of Critical Care Medicine, the First People’s Hospital of Longquanyi District of Chengdu, to analyze the possible risk points of MDRO infections in ICU from then on. FMEA was used to assess risks, and the failure modes with high risk priority numbers were selected to evaluate the high-risk points of MDRO infections. The causes of the high-risk points were analyzed, and improvement measures were formulated to control the risks through PDCA cycle management model. The incidence of healthcare-associated MDRO infections in ICU, improvement of high-risk events, and satisfaction of doctors and nurses after the implementation of intervention measures (from January 2020 to June 2021) were retrospectively collected and compared with those before the implementation of intervention measures (from January 2018 to December 2019). Results Six high-risk factors were screened out, namely single measures of isolation, unqualified cleaning and disinfection of bed units, irrational use of antimicrobial agents, weak consciousness of isolation among newcomers of ICU, weak awareness of pathogen inspection, and untimely disinfection. The incidence of healthcare-associated MDRO infections was 2.71% (49/1800) before intervention and 1.71% (31/1808) after intervention, and the difference between the two periods was statistically significant (χ2=4.224, P=0.040). The pathogen submission rate was 56.67% (1020/1800) before intervention and 61.23% (1107/1808) after intervention, and the difference between the two periods was statistically significant (χ2=7.755, P=0.005). The satisfaction rate of doctors and nurses was 75.0% (30/40) before intervention and 95.0% (38/40) after intervention, and the difference between the two periods was statistically significant (χ2=6.275, P=0.012). Conclusions FMEA can effectively find out the weak points in the prevention and treatment of MDRO infections in ICU, while PDCA model can effectively formulate improvement measures for the weak points and control the risks. The combined application of the two modes provides a scientific and effective guarantee for the rational prevention and treatment of MDRO infections in ICU patients.
ObjectiveTo study the effect of PDCA cycle model on the standardization of the application of common disinfectants, in order to promote the management level of hospital disinfection. MethodsBy questionnaire and observation, the study was to learn the knowledge and its application in medical workers on common disinfectants. Based on the results, we tried to regulate effective preventive measures and carry out continuous improvements. ResultAfter the implementation of PDCA cycle model, the awareness rate of the medical staff on disinfection and the application accuracy of disinfectants were significantly increased (P<0.05). ConclusionThe implementation of PDCA cycle model can improve nosocomial infection management level effectively, ensure medical quality management and patients' safety, which is an effective way of management to reduce the rate of nosocomial infection.
ObjectiveTo strengthen the management of medical equipment and improve the use value of medical equipment by PDCA cycle. MethodsBetween March and June 2014, we introduced PDCA cycle into the management and use of newly-bought equipment.The use of newly-bought arteriosclerosis detector, TCD and ultrasound bone densitometer between March and June 2014 was regarded as the control group (before the implementation of PDCA cycle), and the use of these three kinds of equipment between March and June of 2015(after the implementation of PDCA cycle) was seen as the observation group.By analyzing the status quo through collected information, we drew a fishbone diagram to find out the factors that could influence the use efficiency of medical equipment.Then, corresponding measures were taken for continuous improvement, including adopting revised regulations, training technicians, quantifying work indexes, informatization, changing service mode, and examining and assessing the effect of implementation.Finally, feedback was summarized for the next PDCA cycle. ResultsAfter the implementation of PDCA cycle, the daily check numbers of hospital medical equipment including arteriosclerosis detector, TCD, and ultrasound bone densitometer all improved significantly (P < 0.05).The daily check numbers of those three kinds of equipment after the implementation of PDCA cycle were respectively 48.52±19.72, 32.14±10.14 and 55.59±25.12, while the numbers before were respectively 32.46±20.69, 15.46±10.05 and 29.83±20.20.Moreover, working days, maximum working hours daily, and total working time were also increased after the implementation of PDCA cycle. ConclusionThe application of PDCA cycle can effectively improve the use value of medical equipment, and improve the social benefit and economic benefit.
ObjectiveTo discuss the application and effect of PDCA cycle in urgent values management in surgical intensive care unit. MethodsWe analyzed the quality of 141 cases of urgent value reports in surgical intensive care unit from May to July 2013 before the application of PDCA management. The quality of urgent values were totally controlled by PDCA circle. There were 135 cases of urgent value reports after the use of PDCA cycle. The data including qualify rate of specimens, record specification rate, and handover of urgent values were compared between the two groups of urgent values. ResultsAfter the application of PDCA cycle management, the awareness rate of urgent value content and disposal processes among medical staffs increased from 75% to 95%, with significant improvement in the quality rate of samples, recording and processing of urgent values and the quality rate of recording. ConclusionThe application of PDCA circle management can constantly correct the problems and ensure the policy implementation in the urgent values system in clinical departments, which can promote continuous quality improvement.
ObjectiveTo investigate the effect of PDCA cycle on the overall nursing care of patients in the hemodialysis center. MethodsTwenty hemodialysis patients between June and July 2014 were randomly selected as the intervention group, and another 20 hemodialysis patients between March and April 2014 were chosen as the control group. We compared the two groups of patients in terms of patients' satisfaction and the overall care quality of the nurses. ResultsOne month after the intervention, patients in the intervention group had a significantly higher satisfaction rate than the control group (P<0.05); Nurses in the intervention group achieved significantly higher scores in basic requirements, basic items and effect evaluation than those in the control group (P<0.05). ConclusionPDCA cycle can effectively improve the overall quality of nursing care in hemodialysis center and improve patients' satisfaction.
Objective To explore the application effect of PDCA cycle management on reducing the unplanned overnight recovery rate in patients undergoing transabdominal preperitoneal inguinal hernia repair (TAPP) under the same-day surgery model. Methods The unplanned overnight recovery rate in patients who underwent TAPP at West China Tianfu Hospital of Sichuan University between January and October 2023 (pre-improvement phase) was analyzed. A quality control group was established, and PDCA cycle management was employed to define control objectives and implement strategies to reduce the unplanned overnight recovery rate. The unplanned overnight recovery rate in patients who underwent TAPP between November 2023 and April 2024 (post-improvement phase) was compared with that in the pre-improvement phase. Results After the implementation of PDCA cycle management, the unplanned overnight recovery rate in patients undergoing TAPP under the same-day surgery reduced from 23.87% (37/155) in the pre-improvement phase to 9.05% (19/210) in the post-improvement phase, with a statistically significant difference (P<0.05). Conclusion The application of PDCA cycle in the process management of TAPP under the same-day surgery model significantly reduces the unplanned overnight recovery rate in patients.
ObjectiveTo investigate the effect of PDCA circulation management on pain, psychology and prognosis of patients with thoracic aortic aneurysm in the perioperative period.Methods The clinical data of seventy-six patients with thoracic aortic aneurysm who received perioperative nursing based on PDCA circulation management from April 2016 to March 2017 were retrospective analyzed and these patients were selected as the study group, including 44 males, 32 females, aged 23–65 (47.27±5.87) years. At the same time, 72 patients with thoracic aortic aneurysm who received routine perioperative nursing from April 2015 to March 2016 were selected as the control group, including 41 males, 31 females, aged 24–67 (48.30±5.26) years. The nursing effects of the two groups were compared and analyzed.ResultsThe operation time (t=11.342, P<0.05) and hospitalization time (t=5.986, P<0.05) of the study group were significantly shorter than those of the control group. The visual analogue scale (VAS) scores of the two groups had no significant difference before nursing (t=0.914, P=0.361), but the VAS scores in the study group after nursing were obviously lower than those in the control group (t=5.475, P<0.05). The self-rating depression scale (SDS, t=1.026, P=0.307) and self-rating anxiety scale (SAS) scores (t=7.866, P<0.05) of the two groups had no significant difference before nursing, while the SDS (t=7.657, P<0.05) and SAS (t=7.866, P<0.05) scores in the study group after nursing were obviously lower than those in the control group. The incidence of adverse reactions in the study group was significantly lower than that in the control group (χ2=4.292, P=0.038).ConclusionPDCA circulation management used in patients with thoracic aortic aneurysm in the perioperative period can effectively relieve patients' pain, depression and anxiety, reduce the incidence of adverse reactions, and the prognosis is good.