The conception of attending in charge is introduced.based on the methods of literature review and site investigation,the status of attending in charge system at home and abroad and its characteristics in large general hospital were analyzed.The prospect of applying attending in charge system was discussed.

Values of implementing attending in charge system in large general hospital were discussed.The feasibilities of implementing attending in charge system was analyzed.Management system and institutional was established and effective management methods for separating medical staff's position from title in large general hospital has developed and has given an effective way to sub-special department management.Evidence has given for extending and applying attending in charge system in large general hospital.

Based on compact organization,rigorous plan,experience of pilot department,attending in charge system has progressively implemented in all clinical departments.A suit of attending in charge management modes and monitoring mechanisms are formed which includes responsibilities,qualification,appointment and evaluation.by pilot program and application development.Concrete schemes for applying in general hospital are offered.

OBJECTIVE To investigate hand hygiene of healthcare workers in burn ward in our hospital and provide scientific basis for the effective prevention and control of hospital infection in burn ward. METHODS Selected randomly 30 healthcare workers in burn ward and sampled from hands for bacterial culture. RESULTS The average colony of hand pathogens of the 30 healtheare workers was 105.42 CFU/cm~2 , the maximamwas 1093 CFU/cm~2.Among the hand pathogens, 40.91% were Bacillus subtilis, 36.36% were microcoecus and 13.64% were Staphylococcus aureus. CONCLUSIONS Hand hygiene of healthcare workers are not optimistic in burn ward.Strengthening the education of hand hygiene and raising the executable rate of hand hygiene are important measures to prevent and control the hospital infection in burn ward.

Based on the experience of developing quality year, management year, effectiveness year and the Olympic year in General Hospital of P.L.A., the practice and thoughts on improving hospital strategic goals by different subject year was discussed. To implement a subject year, the process as well as subject determation, action guideline designing, organization, implementation and evaluation were considered to be highlighted.

Based on the experience of General Hospital of PLA, The article introduced the practice and experience of management on enhancing medical safety from clinical entrance of doctors, new technology and operations.

Based on the experience of General Hospital of P.L.A.,the article introduced the practice and experience of management on surgery grading access from several aspects including guiding ideology,organization,Qualification,standards and procedure of access,skills training,regulatory etc.

Surgical medicine develops rapidly,however,currently there is no unified standard for permitting operation,and management on operation system is not perfect. Based on hospital experiences,the author proposed to reform qualification management of operations from aspects as management mechanism,operation classification,technical post and category of operation,standard and process for permitting operation etc.

奥运医疗保障工作是关注人数最多、保障规模最大、理念技术要求最高、医疗事件传播最快、影响范围最大,强度最深远的医疗保障工作.

In order to raise the patient-centered idea and change the unreasonable title structure of doctors and improve the basic medical quality,we carried out the responsibility system of attending doctors.Based on the full research and pilot,the practice that was a new exploration of medical management began under the premise of total separation between evaluation and employment in clinic departments.The reform made great achievement in the following aspects,which were changing the unreasonable staff structure and enhancing the enthusiasm and sense of responsibility of medical staff.

Objective: To discuss the reforger of hospital's service flow for inpatients by investigating and analyzing the awareness rate, cure rate and control rate of inpatients with chronic diseases. Methods: A questionnaire survey was conducted in 1071 inpatients in a major hospital in Beijing. The data were typed in Epidata and analyzed with SAS 6.12. Results: Most of the inpatients with hypertension or diabetes were hospitalized in different departments, and their awareness rate, cure rate and control rate of the diseases were not ideal. The scheme of the hospital's service flow recreation was put forward preliminarily. Conclusions: The hospital's service flow should be reforged. Inpatients with chronic diseases should be emphasized and treated correspondingly during the therapy of the disease they recounted in different specialized departments. Then the quality of hospital service would be improved.

目的通过总结我院的SARS防治工作,探讨落实突发公共卫生事件应急条例在医院实施的具体办法. 方法自2003年3月2日～6月24日我院累计收治110名SARS疑似或确诊病例,发生SARS医院感染30例;应对疫情的主要做法是:及时正确处置首次疫情,加强法律法规学习,建立健全制度,完善预防监控体系和机制,按传染病的3个环节科学防治,发挥专家和技术优势,确保医疗保健工作正常运转. 结果通过采取系列措施,自2003年4月10日以来,全院工作人员实现了零感染,无SARS医院感染发生;当北京SARS疫情高峰到来时,我院已做好应急机制构建、人员防护措施到位,做到防疫医疗两手抓. 结论综合性医院应加强应对突发公共卫生事件的疫情监测、预警体系和应急机制建设;医院感染管理机构应突出疾病控制职能;赋予"三基三严"训练以新的要求和内涵;切实做好应急救治场所及防护设施的建设和物资储备.

在临床路径管理中,要进行合理的时间管理,制定合理住院天数是最为重要的内容之一[1].采用项目时间管理的方法[2-4],制定标准住院天数,一方面可以使临床路径开发小组成员清楚地掌握整个诊疗过程及过程中各专业的职责;另一方面还可以科学地制定出最佳诊疗时间标准,方便简单,符合实际[5,6].下面以制定膝骨性关节炎行关节镜手术为例进行说明.

To insure other sufferers ,doctors and nurses' safety in hospital during SARS,We analysed procudures and management keystones of remedy work,set down and carried out project and measures of sufferer management. We avoid happening intercross infection in hospital effectively.

Objective:To study and evaluate the measures of control in SARS hospital infection. Methods:Definite SARS patients (inpatients and medical staffs) were selected from a general hospital between March and June 2003. Individual and environment survey were carried out by a standardized questionnaire of China CDC. Results:There were 30 SARS cases of hospital infection. Epidemiological characteristics: There were two peaks of incidence (Mar 13th -16th and Mar 24th). Distributions by places were confined to Ward 4, 5, 6 on the 7,8,12,13 and 14 floors in west unit of the inpatient building. Among the SARS cases, the inpatients were older and most had severe original diseases, and the medical staffs were younger juniors. Source of transmission: Index patients were the first generation source of transmission and the secondary attacked inpatients and medical staffs were the second generation. Route of transmission: The major transmission routes were near space droplet infection and close contact infection. There was a probability of aerosol or droplet nuclei transmission through the ventilation system. Conclusions: Hospital infection was the main epidemic form of SARS in the early stage. Many measures such as control and isolation of the source of transmission, setup of the fever clinic and medical observation area, isolation and medical observation of suspected cases, enforcing ventilation and disinfection of the ward area, stopping fresh-air system, forbidding outside visiting, strengthen prevention of medical staffs were carried out and the SARS hospital infection could be prevented and controlled.

To do good the medical treatment management work after issuing and actualizing ofOrdinance of Dealing with Medical Treatment Accident(Abbreviation:Ordinance), it was expounded in this article that in the hospital manages work, strengthening full member training, and raising the regulations consciousness; strengthening the evidence management, and doing good the quoting preparation; strengthening the communicating and intercommunion, osculating the relation of the doctor and patient; reducing the medical treatment risk, and exploring the new countermeasure. The preparation should be done for the completely implementation of 《Ordinance》.

住院诊疗质量实时控制是一项旨在提高住院诊疗质量的系统工程,其核心在于突出"预防为主",实现控制方式的"四个转变".它由控制目标、控制主体、控制对象、控制手段及工具系统四要素组成,通过前馈控制、现场控制、反馈控制而实施,并经持续质量改进而达到住院诊疗质量的循环上升.住院诊疗质量实时控制的实现有赖于四个方面:以过程方法、持续质量改进和控制论为理论根据,以标准的建立和完善为基础,以计算机实时监控系统为保障,以全员参与、病人监督为更高要求.

笔者从我军医疗保障制度的现状、现行医疗保障体制存在的问题等方面对军队医疗保障制度改革有关问题进行了分析,认为突出保障对象的重点和主次;多渠道筹集保障经费,对医疗费用的结算进行改革;更新观念,医疗保障水平耍与社会主义初级阶段的国情相适应;触及单位、个人的实际利益;加强医患间的双相控制和充分利用国家深化劳动就业、人事制度、医疗保障制度改革契机,减轻军队负担是现阶段军队医疗保障制度改革需要重视的几个问题.

Medical treatment quality is an important standard to evaluate the whole level of hospital and the core of hospital management. The author brings forward the conception of real-time control system of medical treatment quality .Pilot study and research are carried out in real-time control system ,the meaning of real-time inspect and control and content and process during achievement of tache quality. The new mode of hospital medical treatment quality with our country characteristic is researched and established from hospital management angle through series job.

一、HIS信息质量保证结构分析 ISO9000标准ISO8402对“质量”的定义是反映实体满足和隐含需要能力的特征的总[1]。因此，医院信息质量的目标是最大限度地满足医院管理、医疗及操作层各类用户的需要。围绕医院信息质量有关因素，将医院信息质量保证结构可分为3个层次，如图1所示。信息质量最终体现在用户满意上，它以高质量信息为基础，这种高质量信息又取决于系统要素、数据要素、管理要素及服务要素质量。这4种信息要素质量要求与内容见表1。