刘宏见等

摘要：目的： 探析医护一体式整体责任包干方式在以系统疾病为中心的多学科融合病区护理管理中的应用效果。方法： 选择我院以系统疾病为中心的多学科融合病区的住院的患者和护理人员为实验对象，随机分成对照组和观察组。观察组采用一名主管医生配备一名固定的责任护士的“一体式”整体责任包干的护理模式；对照组采用传统的责任护士分管数个病房但不与具体医生搭配的“分体式”整体责任包干的护理模式，观察患者对护理工作的的满意度、医生对护理工作的满意度、护理不良事件发生率、患者平均住院日等指标。结果： 观察组患者对护理工作满意率为96%，明显高于对照组的91%，对比差异明显，有统计学意义（P<0.05）；观察组医生对护理工作的满意率为94%，明显高于对照组的86%，对比差异明显，有统计学意义（P<0.05）。观察组护理不良事件发生率为2.6%，同对照组9.0%比较，明显较低，有统计学意义（P<0.05）；观察组患者住院时间同对照组比较，明显较短，有统计学意义（P<0.05）；结论： 医护一体式整体责任包干模式在以系统疾病为中心的多学科融合病区的应用可以有效改善责任护士对患者病情的掌握情况，提高责任护士与主管医生的沟通效率、默切程度，降低护理不良事件发生率，提高患者及医生对护士工作的满意度，缩短平均住院日。

關键词：医护一体式整体责任包干模式；效率；护理；

重庆市医学科研计划项目资助（项目号2012-2-148）

Abstract： Objective To analysis to the application of hierarchical management model in the center of the medical care management effect. Methods select our hospital physical examination center of 34 nursing research management staff as the research object， randomly divided into control group and observation group. Control group using conventional method to a medical center in nursing management work， observation group adopts hierarchical management mode to carry out the nursing management of physical examination center， observe the physical examination personnel of nursing management， job satisfaction， two groups of research object for the management of nursing error rate and average number of checkup every day. Results in the observation group no nursing staff in the medical work error， error rate is 0， the control group a total of three （5.88%） of nursing management staff went wrong； A month time， 17 workers on an average day in the observation group receied medical personnel is controlled in 72 cases， control group is controlled in 56 cases， work efficiency is significantly higher than control group； Medical personnel to observe group medical work satisfaction rate of 99%， significantly higher than the control group 91%， more than two sets of comparison difference to be markedly， with statistical significance （P < 0.05）. Conclusion the application of hierarchical management model in the center of the medical care management can effectively improve the relevant personnel sense of responsibility， make them more clear responsibility， at the same time for different work experience of the nursing managers are promoted， and thus a medical error rate， improve the quality of check-up crowd's satisfaction with the work.

Keywords： Hierarchical management mode； Efficiency； Physical examination； nursing

临床多学科工作团队（multidisciplinary team， MDT）[1-6]是两个以上的相关学科组成固定的工作组，针对某种疾病进行定期定时的临床讨论会，提出临床治疗方案。MDT在建立多科联合诊疗医护团队的基础上，打破内外科分离的旧格局，按系统疾病分配医疗空间，把同一系统疾病的相关内科和外科从空间上布局到一个病区，缩减同一系统疾病内外科的空间距离。MDT医疗服务模式要求护士对疾病有更广泛和多学科认识，要求护士对病人更深入、细致和全面的护理。

目前国内主流医院采用的护理工作模式是整体责任包干、小组负责制工作模式。……