Improving the quality of medical care is the core of hospital management. On March 2, the General Office of the National Health Commission issued the Notice on Printing and Distributing the National Medical Quality and Safety Improvement Goals in 2022 (hereinafter referred to as the "Notice").
The "Notice" pointed out that in order to further play the important role of the goal in promoting the improvement of medical quality and safety, the National Health Commission has formulated the "2022 National Medical Quality and Safety Improvement Goals" on the basis of the work in 2021, combined with the outstanding problems and weak links in the medical quality and safety reflected in the annual quality and safety report data, and guided the national quality control centers to study and formulate the "2022 Quality Control Work Improvement Goals for Each Profession" (hereinafter referred to as the "Goals").
The "2022 National Medical Quality and Safety Improvement Goals" has a total of 10 items, which are:
1. Improve the treatment rate of acute ST-segment elevation myocardial infarction reperfusion;
2. Improve the rate of reperfusion treatment of acute cerebral infarction;
3. Improve the clinical TNM staging evaluation rate before tumor treatment;
4. Improve the rate of pathogenic examination in hospitalized patients before antimicrobial treatment;
5. Improve the normative prevention rate of venous thromboembolism;
6. Improve the completion rate of infectious shock cluster therapy;
7. Improve the reporting rate of adverse events in medical quality and safety;
8. Reduce the rate of unplanned return to the operating room for re-operation;
9. Reduce the use of intravenous fluids in hospitalized patients;
10. Reduce the incidence of complications in vaginal delivery.
For these 10 goals, the document gives a "brief description of the goals" and the corresponding "core strategies". For example, in "Reducing the Use of Intravenous Fluids in Hospitalized Patients", the Objective Brief states that intravenous fluids have an irreplaceable role in treating certain diseases and saving patients.
However, the irrational use of intravenous infusion therapy not only fails to improve the treatment effect of patients, but also has more safety hazards and increases unnecessary medical costs. The "National Medical Service and Quality and Safety Report" for several consecutive years shows that the proportion of inpatients treated with intravenous fluids in hospitals above the second level in the mainland remains high, and comprehensive measures need to be taken to intervene.
In "Reducing the Incidence of Complications of Vaginal Delivery", the goal brief points out the urgency of improvement: the National Medical Service and Quality And Safety Report shows that the incidence of complications of vaginal delivery has been increasing in recent years.
"2022 Quality Control Work Improvement Goals for Various Professions" has a total of 40 items, which put forward "improvement goals" for case management, pathology, obstetrics and other majors, and gives the corresponding "brief description of goals". The objectives are briefly directed at the current situation and problems, such as the "Reducing the Use of Antimicrobial Drugs in Patients with Viral Pneumonia" for infectious disease specialties: in the case of no co-bacterial infection, patients with viral pneumonia do not need to use antibacterial drugs.
However, at present, the use rate of antibacterial drugs in patients with mild to moderate viral pneumonia in some areas exceeds 90%, of which the irrational use rate exceeds 70%, and it is urgent to intervene.
In the "Improving the Intervention Rate of Early Rehabilitation of Inpatients" for the rehabilitation medicine profession, it is pointed out that the National Medical Service and Quality and Safety Report shows that in the past three years, the early rehabilitation intervention rate of inpatients in mainland general hospitals has increased year by year, but it is still at a low level. At present, the focus is on the early rehabilitation intervention rate of inpatients in orthopedics, neurology, neurosurgery and critical care medicine.
Why are these two goals being added?
According to the interpretation of the National Health Commission, the 2022 target is the inheritance and development of the 2021 target. Among the 10 national medical quality and safety improvement goals in 2021, 8 of them will continue to be the 2022 goals, and the remaining 2 will continue to be promoted as the quality control improvement goals of various professions to ensure the continuity of related work.
According to the outstanding weak links reflected in the data of the 2021 National Medical Quality and Safety Report, two national medical quality and safety improvement goals of "improving the completion rate of clustered treatment for septic shock and reducing the rate of unplanned re-entry to the operating room" have been added in 2022.
Septic shock has the characteristics of high incidence, high case fatality rate and high treatment cost, and has become the leading cause of death in severe patients in the middle and late stages.
The National Medical Service and Quality and Safety Report shows that there is still much room for improvement in the clustered treatment of patients with infectious shock in mainland China.
Increasing the completion rate of 1-hour and 3-hour cluster therapy in patients with septic shock can significantly improve patient outcomes.
With regard to the goal of "increasing the completion rate of clustered treatment for septic shock", the Improvement Plan proposes four core strategies, the first two of which are:
1. Medical institutions shall establish a special working group composed of relevant departments such as severe illness, emergency treatment, infectious diseases, testing, and medical affairs, and designate the lead department.
2. Medical institutions regularly carry out relevant training to ensure that medical staff are proficient in relevant diagnosis and treatment norms, and can identify relevant patients in a timely manner and give standardized treatment.
The rate of unplanned re-entry to the operating room is one of the common indicators of surgical quality and safety in the industry. It can occur due to a variety of causes, including inadequate preoperative evaluation, surgical design flaws, surgical errors, or inadequate postoperative management of patients.
The National Medical Service and Quality And Safety Report shows that the rate of unplanned return to the operating room in mainland China has not improved significantly in recent years.
With regard to the goal of "reducing the rate of unplanned re-entry to the operating room", the "Improvement Plan" proposes four core strategies, the first two of which are:
1. The medical institution shall establish a special working group composed of relevant departments such as medical affairs, clinical departments, anesthesia, and nursing, and designate the leading department.
2. Medical institutions strengthen surgical management, and ensure that surgical management systems such as hierarchical surgical management, physician authorization management, preoperative discussion system, and surgical safety verification system are in place.
The health community has noted that for these 10 goals, the core strategies proposed in the Improvement Plan are basically similar, namely:
1. Medical institutions shall establish a multi-departmental joint monitoring and evaluation mechanism for the indicator, clarify the data collection methods and internal verification procedures of relevant quality control indicators, conduct data analysis and feedback on a quarterly and sub-department basis, incorporate performance management, and establish incentive and constraint mechanisms.
2. Medical institutions use quality management tools to find and analyze the factors affecting the achievement of the goal of the institution, clarify the key reasons according to the analysis results, formulate improvement measures and organize their implementation.
It can be seen that keywords such as joint monitoring and evaluation mechanism, incentive and constraint mechanism, and quality management tools, under the joint promotion of health administrative departments at all levels, medical institutions, quality control organizations and industry associations, will become an important starting point for hospitals across the country to improve the level of medical quality and safety management with the gradual implementation of the "Goals".
"In 2021, our committee released the national medical quality and safety improvement goals for the first time, which was highly concerned by the whole industry, and all parties actively carried out implementation work around the relevant goals, and achieved remarkable results. It fully proves the feasibility, effectiveness and important role of goal management in the field of medical quality and safety." In the interpretation of the "Goals", the National Health Commission explained the significance of formulating relevant goals.
When explaining why the targets are released on an annual basis, the interpretation of the Targets points out that with the development of the industry and the advancement of work, the medical quality and safety situation will change to a certain extent every year. In particular, after the release of the national medical quality and safety goals, the industry has carried out targeted improvement work, some weak links and prominent problems have been significantly improved within 1 year, and related improvement work has entered a benign track. At the same time, there are also some new problems and weak links that have been exposed and have become the focus of attention.
Include in performance appraisal! How else can you drive your goals?
The interpretation of the "Goal" pointed out that the realization of the goal requires close cooperation and joint promotion of health administrative departments, medical institutions, quality control organizations and industry associations.
1. Health administrative departments at all levels should take the promotion of the realization of the goal as the annual focus of work, and guide the quality control organizations and all types of medical institutions at all levels in the jurisdiction to carry out improvement work.
2. All types of medical institutions at all levels should actively innovate working mechanisms, methods and methods, promote multi-departmental and multi-disciplinary collaborative work within the institution, formulate management organizational structures, relevant systems, working mechanisms and implementation paths that conform to the actual conditions of the institution in accordance with the core strategies of each goal, establish incentive and constraint mechanisms, and fully mobilize the enthusiasm of relevant management personnel and medical personnel.
3. Each professional quality control center should take the improvement goal of the quality control work of the major as the annual core work, continue to provide technical support for the realization of the goal, refine the relevant improvement strategy, strengthen the publicity and training, and do a good job in the collection, analysis and feedback of data and information.
4. Relevant industry organizations should make use of their own advantages, actively carry out research and exchanges around the goal, build a government-led, industry self-discipline, institutional autonomy, multi-party participation of the medical quality and safety management pattern, and jointly cultivate the medical quality and safety industry concept and culture of full attention and full participation.
Sources | the health community
Written by | Liu Wenyang
Producer | Zheng Yujun