目的 探讨新型冠状病毒肺炎疫情下门诊管理和运行新模式的建立,为疫情下军队三甲医院门诊高效运行提供方法.方法 结合国内医疗机构新型冠状病毒肺炎疫情下门诊运行相关经验,通过加强预检分诊管理、合理开展普通病区诊疗活动、强化院内感染感控,实现疫情下门诊管理模式的转变.结果 2020年2月1日至4月30日,针对门诊管理中的9个具体流程进行优化,医院共接诊患者342 480例,实现员工"零感染",患者及陪同者"零漏诊",门诊患者满意度达到98％.结论 通过优化门诊管理各流程,完成疫情条件下门诊流程再造,但仍需要在实践中不断更新和完善.

Objective To analyze the diagnosis and treatment data after the adjustment of various measures in the hospital fever clinic during the coronavirus disease 2019 (COVID-19) outbreak, so as to provide experience for the prevention and control of COVID-19 in non-epidemic areas Methods We collected the diagnosis and treatment data from the fever clinic of Changhai Hospital of Naval Medical University (Second Military Medical University) in non-epidemic area from Dec 21, 2019 to Feb 22, 2020 and Jan 1 to Mar 5, 2019, and divided them into four groups: Group A (during the 2020 COVID-19 epidemic), from Jan 22 to Feb 22, 2020;group B (before the COVID-19 epidemic), from Dec 21, 2019 to Jan 21, 2020;group C (in the same period as group A in 2019), from Feb 2 to Mar 5, 2019;and group D (in the same period as group B in 2019), from Jan 1 to Feb 1, 2019 Year-on-year and month-on-month comparisons of the above data were conducted Results The overall situation of the fever clinic around the Spring Festival in 2020 was similar to that of the same period in 2019 The year-on-year comparison results showed that during the COVID-19 epidemic, the number of daily patients in the fever clinic was significantly decreased ([114 3±62 9] cases vs [171 7±37 0] cases), the single consultation time of each physician was prolonged ([11 7±1 8] min vs [6 5±1 3] min), but the average waiting time of patients was decreased ([7 5±0 6] min vs [22 8±1 5] min) (all P<0 05) The month-on-month comparison results indicated that the number of daily patients in the fever clinic was significantly decreased during the COVID-19 epidemic ([114 3±62 9] cases vs [216 3±41 8] cases), the single consultation time of each physician was prolonged [( 11 7±1 8] min vs[ 5 6±0 8] min), but the average waiting time of patients was decreased ([7 5±0 6] min vs [23 3±3 2] min) (all P<0 05) The proportion of computed tomography (CT) examination during the 2020 COVID-19 epidemic was significantly higher than that in the same period of 2019 (7 9%[ 292/3 658] vs 3 7% [206/5 493]) Although the examination time was prolonged due to strengthened protective measures ([12 5±3 8] min vs [10 0±3 2] min) (P<0 05), the time for patients to have the CT examination report was significantly shortened ([10 6±2 5] min vs [58 4±9 6] min) (P<0 01) Conclusion During the COVID-19 epidemic, measures such as adjusting the relevant procedures of the fever clinic and equipping special CT machine in non-epidemic area can reduce the daily consultation time of physicians, improving the diagnosis and treatment efficiency and reducing cross infection

目的 通过电子通行证的使用,保障患者在新型冠状病毒肺炎流行期的就诊过程安全、快捷.方法 2020年2月,便利抽样法选取上海市某三级甲等综合医院门诊就诊的患者为研究对象.设计开发预检筛查小程序并生成患者电子通行证;比较电子通行证应用前后门诊患者预检筛查时间、就诊或检查时医生问诊时间.结果 电子通行证应用后,门诊患者筛查时间、就诊或检查时医生问诊时间较电子通行证应用前均明显缩短,差异均有统计学意义(均P＜0.001).结论 在新型冠状病毒肺炎流行期间,应用电子通行证可提高患者的就诊效率,保障患者就诊安全,有效应对突发公共卫生事件.

目的 通过高效的预检分诊导诊工作,可以及时甄别患者是否进入发热门诊流程,保证就诊效率.方法 准备阶段,包括物品、环境的准备,分诊导诊护士的培训;实施阶段,使用信息化筛查工具,创建科学预检分诊流程,合理分区,规划路线,引导患者就诊.结果 新型冠状病毒肺炎流行期门诊患者就诊流程通畅,门诊医疗工作高效运行,防止交叉传播.结论 新型冠状病毒肺炎流行期,应该加强门诊预检分诊导诊工作的服务措施,确保患者及时高效就诊,避免交叉感染.

门诊是医院服务患者的主要场所,各类工作流程错综复杂,部门交叉非常普遍.在门诊量逐日递增的今天,各大医院采取智慧门诊提高医疗服务效率,然而患者的就医体验、员工的工作状态并未得到保证.某院采用走动式管理,成立门诊四级走动式管理团队,通过现场管理、细节管理、互动管理、追踪改善管理、情感管理和人力资源管理,全面全程全覆盖,变被动型管理为主动型和开拓型管理,营造管理者、患者和基层员工三者之间的和谐非正式交流沟通气氛,最终促进智慧门诊服务质量的整改与提高.

Objective To adopt the concept of lean management in improving the use of self-service facilities in outpatient service, optimizing the service process and effectively shortening patients' queuing time. Methods Lean management tools were adopted in project evaluation, measures improvement, effect assessment and follow-up improvement. Results and Conclusion Lean management can effectively improve the self-service facilities, so in order to achieve its better effects, importance should be attached to the management with administrators' attention as the basis, with patients' needs as the core and with accurate data collection as the effective means.

As public welfare service for patients, hospital volunteer service is a product of the progress of modern civilization and an important way for the citizens to participate in social management, to serve society construction and to promote harmonious society.With strong affinity, volunteer service can effectively improve patients' experience and thus has recently attracted great attention from all kinds of hospitals.Volunteer service has become an integral part of outpatient medical treatment process.As a service system independent from the hospital medical services and drug service within a hospital and also as a link between hospitals and patients, volunteer service can improve patients' treatment experience, raise service satisfaction, and plays an important role in optimizing outpatient service process and promoting the harmonious doctor-patient relationship.

Objectives:To analyze the change of patients' total medical cost before and after hospitalization costs with the implementation of pre-hospitalization examination in the hospital outpatient department and to simulate the change pattern of medical insurance patients' out-of-pocket expenses and medical insurance payment cost in order to provide reference for decision making.Methods:Totally 1928 patients of 41305 cases of hospitalized patients with standard rate data were selected for the study,eligible from a hospital between April 2013 and December 2013.After simulating the cost according to the relevant roles of the Shanghai medical insurance,multiple linear regression and quantile regression analysis were applied for the comparison of differences among the patients in treatment (pre-hospitalization examination) group and in control (traditional examination) group.Results:There was no statistically significant difference in the total cost,simulated out-of-pocket expenses and medical insurance fee for patients between treatment group and control group in total medical cost,out of pocket cost and medical insurance cost.It also showed that the surgery patient's the total cost,simulated out-of-pocket expenses and medical insurance cost in some quantiles might be decreased.Conclusions:The integration of pre-hospitalization examination does not increase the patient's medical expenses burden and the pressure on the medical insurance department.

Objective To investigate the application of WeChat public platform in the optimization of outpatient medical treatment.Methods After the establishment of "Shanghai Changhai Hospital" WeChat public platform, the functions of appointment registration, mobile payment, inspection and inspection results query, real-time information query, health reading were then integrated into the platform.The number of public use of this WeChat public platform was analyzed, and then was compared with other treatment methods.In the outpatient clinic, patients were randomly assigned to treatment group and WeChat group(n=200 per group).The visiting time of the two groups was compared.Results The WeChat public platform simplified the treatment process, and improved the patient time utilization.The number of outpatient clinics through the appointment of WeChat public increased monthly.The time spent on patients in the registration, payment, reports were significantly reduced in patients with application of WeChatplatform.Conclusion The WeChat public platform changes the traditional mode of medical treatment, turning humane and intelligent medical environment into a reality.With the promotion of the concept of online medical treatment, the application of internet terminal for medical treatment will be the future trend of medical development.

Objective To analyze the effect of the time-phased appointment system in the wound clinic. Methods By convenience sampling,1719 cases from October 2016 were selected as observation group, and applied with time-phased appointment;the another 2941 cases from October 2015 were selected as control group,and applied with routine drassing change method.The waiting time,break time,work overtime and the difference in the patients'satisfaction of the two groups of patients were compared be-tween two groups.Results The waiting time,break time and work overtime in observation group were shorter than that of control group (all P<0.01),and the satisfaction rate was higher than that of control group (P <0.01).Conclusion The time-phased appointment system can effectively shorten patient waiting time,enhance efficiency of the wound management center and improve patient clinic experience.

为了缩短患者平均住院时间和术前住院天数,有效缓解患者住院难问题,第二军医大学长海医院在门诊开展一体化院前检查服务,将患者入院后必须进行的各项手术前(治疗前)检查,前移至待床阶段在门诊完成,在不增加患者和医保部门费用的同时,缩短待床和住院时间,有效改善患者的就医体验.

Objective To explore the effectiveness of the practice of quality control circle that shortens re-ception time for patients in the pre -hospitalization examination center .Methods Establish quality control circle group , analyze key issues that affect reception time in the pre -hospitalization examination center through proce-dures and methods of the quality control circle , set goals and countermeasures , and evaluate the effectiveness after the implementation of the measures .Results The application of quality control circle has effectively shortened re-ception time for the pre-hospitalization patients , with the reception time shortened from 99 .5 minutes previously to 64 minutes , and at the same time , improved the circle members'working ability and management awareness .Con-clusion The application of quality control circle can establish a standardized and effective process of pre -hospi-talization patient service , shorten the reception time for patients in the pre -hospitalization examination center , and improve the staff's team spirit and work enthusiasm .

目前,以慢性伤口护理为主要内容的门诊伤口护理工作正逐步得到医院管理者和门诊医护人员的重视。2011年2月,第二军医大学长海医院成立了伤口管理中心,在接诊量稳步提高、伤口管理水平不断提升的同时,笔者也发现,患者在伤口管理中心就诊的过程中存在候诊时间长、满意度不高等问题。精益管理(lean management)源于日本丰田汽车公司丰田生产体系(toyota production system)的一整套科学管理模式[1]。目前,国内已有医院运用精益管理手段对医院药房、手术室等部门进行流程改造,取得了较好的效果[2]。第二军医大学长海医院门诊部也曾在军人就诊管理、检验科流程改造等方面运用了精益管理的理念[3]。为此,2014年1月,本课题组应用精益管理理念,贯彻以人为本的服务宗旨,对伤口管理中心的流程进行了全方位的改造,有效缩短了患者的候诊时间,改善了候诊环境,提升了患者的就医体验,现报道如下。

Objective To investigate the effect of pre-hospital examination service on shortening the aver-age duration of preoperative hospital stays .Methods Totally 2706 cases were selected and divided into post-hospital examination group (n=1896) and pre-hospital examination group (n=810) ,and the hospi-talization stay time were compared .Results The average duration of hospital stay in pre-hospital group and post-hospital group was (4 6.9 ± 2 6.5) and (3 .76 ± 2 .28)d respectively (t=8 7.97 ,P<0 .05) .Conclusion The pre-hospital examination service can significantly shortened the hospitalization days ,which can elevate the efficiency in surgical departments .

The author is a member of Liberia's medical team. The whole process of Ebola adopted hemorrhagic fever treatment unit (ETU) such as the design idea, workflow and its management are carefully learned. Followed the technical standard issued by WHO and referred the experiences of the construction standard of infectious disease hospital, the separated contaminated area, semi-contaminated area, clear area and the separated staff channel and patient channel are built to match the requirement of Ebola treatment and give both patient and medical staff a safe and clean environment as well. Combined with the climate characters of western Africa, the only ETU built by prefabricated material in total 18 ETUs in Liberia which has divided into clinic area, observation area, treatment area, health prevention area, switching station, information center and storehouse has been finished and used. And it is the only full video surveillance ETU monitored by Junwei No.1 system.

The development path and application status of the Occupational Health Management System (OHSMS) after it was introduced into China was explored through domestic and international literature review. It is proposed that enterprise management and production behavior will undergo significant changes under the new standard.

ObjectiveTo explore the cause of cancelling and exchanging registration in surgery outpaient in class Ⅲ comprehensive hospitals and put forward the improvement measures to provide reference to lower the rate of cancelling and exchanging registration.Methods The number of cancelling and exchanging registration in surgery outpatient from December 2nd to 29th in 2013 was retrospectively analyzed,which was compared with the number of the whole hospital during the same period.The reasons of patients' cancelling and exchanging registration were manually coded,and the top 12 reasons were separately collected.The causes were investigated and researched to analyze its shortness and put forward countermeasures.Results The rate of cancelling and exchanging registration in surgery outpatient was 10.1%.The first reason was long time waiting to see the doctor,which accounted for 18.2%.The second reason was the registration error and change of experts,which accounted for 16.2% and 15.6% respectively.It's relatively high compared with 6.9% cancelling and exchanging registration of the whole hospital.Conclusion The hospital should establish standard management system of cancelling and exchange registration,strengthen the multi management training of registration personnel,precheck and triage personnel and the outpatient doctors, and improve the quality of surgical outpatient medical service.

Objective:To analyze the detection of physical abnormality among enterprise workers at different time points between 2009 and 2011,and to analyze the significance of the detection and related interventions of chronic diseases during the three years’ period.Methods:This study focused on the retrospective analysis of physical examination data by using the frequency and percentage in statistical description. Chi-square analysis was employed for statistical inference to compare the indicators between groups.Results:Statistics showed that medical abnormality detection rates of subjects were different at different time points. There were also differences of disease detection rate at three different time points(P<0.01).Conclusion:There are positive changes of overall health among enterprise employees. The changes of different kinds of diseases are different. Effects of non-chronic diseases interventions are obvious. It is suggested to continuously monitor the chronic diseases and conduct active health interventions.

Objective:To analyze the health status of entrepreneurial community residents,and to make a comparative analysis between different types of communities.Methods:The physical examination data were statistically analyzed. Frequency and percentage were used for descriptive statistical analysis. Chi-square analysis was conducted for group distribution comparison.Results:Abnormal rate of physical examination results among entrepreneurial community residents was 87.33%. Residents in entrepreneurial communities and living communities had discrepancy in the disease spectrum and disease severity. Community residents of different gender and age also had discrepancy in detection rate distribution in most kinds of diseases. Conclusion:Health status of entrepreneurial community residents have specificity compared with those of the living community residents. Health monitoring and disease control interventions are suggested to be designed for entrepreneurial community residents with different demographic characteristics.

Objective:To make statistical description of health behaviors of entrepreneurial community residents,to analyze the relevance between health related behaviors and health status and to make suggestions for optimizing health education and behavior intervention.Methods:This study surveyed subjects with structured questionnaires. Physical examination results were also used in combination with surveys for analysis. Frequency and percentage were used for descriptive statistical analysis. Non-conditional logistic regression was used for multivariate analysis.Results:Overall,health-related behaviors of the population were poor,which correlated with the sample characteristics. The influencing factors of different health related behavior were also different.Conclusion:Health education and interventions based on influencing factors will have better effects.