应用出科人次计算科室平均住院日和病死率的研究
姜鹤，罗燕，许丹圆，宁星，徐俊，贾梅霞1
香港大学深圳医院，广东 深圳 518000
第一作者：姜鹤（1992— ），女，硕士研究生，研究方向为医院数据统计分析。联系电话：18002452202，E-mail：jianghe17_crisp@163.com
通讯作者：贾梅霞（1981— ），女，本科，中级职称，主要研究方向为医院等级评审、不良事件管理和医院数据统计分析。联系电话：13421839396，E-mail：82333597@qq.com
摘要：目的 考虑转科患者的影响，研究应用出科人次计算平均住院日和病死率，促进医院精细化管理。方法 选择某医院2023年1月至10月期间46个亚专科55283名出院患者作为研究对象，利用SQL脚本计算亚专科平均住院日、平均住科日、病死率和校正病死率。采用配对t检验分析差异，P＜0.05认为差异具有统计学意义。结果 含有转科患者的亚专科占比93.48%，说明科室之间转科较为频繁。出院人次与出科人次差异具有统计学意义（P=0.001）；出院者占用总床日数与出科者占用总床日数差异无统计学意义（P=0.997）；平均住院日与平均住科日差异有统计学意义（P=0.012）；病死率与校正病死率差异无统计学意义（P=0.145），但重症医学科病死率与校正病死率差异较大。结论 转科患者的影响不容忽视，建议应用出科人次计算平均住院日和病死率，以促进科室间横向对比和医院精细化管理。
关键词：出科人次；平均住院日；平均住科日；病死率(https://www.daowen.com)
Study on calculating the average length of stay and case fatality rate of department by the number of discharges from department
Jiang He, Luo Yan, Xu Danyuan, Ning Xing, Xu Jun, Jia Meixia
The University of Hong Kong - Shenzhen Hospital, Shenzhen 518000, China
Abstract:Objective Considering the impact of transferring patients, the study applies the number of department discharges to calculate the average length of stay and case fatality rate, and promotes the fine-tuning of hospital management.Methods A total of 55283 discharged patients from 46 sub-specialties in a hospital from January to October 2023 were selected for the study.The average length of stay, average length of stay in department, case fatality rate and corrected case fatality rate were calculated by SQL script.Paired T-test was used to analyze the differences, and P＜0.05 was considered statistically significant.Results The percentage of sub-specialties containing transferred patients was 93.48%, indicating more frequent transfers between sub-specialties.There was a statistical difference between the number of discharges and the number of discharges from department (P=0.001);The difference between the total number of bed days occupied by discharges and the total number of bed days occupied by department discharges was not statistically significant (P=0.997);The difference between average length of stay and average length of stay in department was statistically significant (P=0.012);The difference between the case fatality rate and the corrected case fatality rate was not statistically significant (P=0.145), but the difference in intensive care unit was greater.Conclusion The impact of transferred patients should not be ignored, and it is recommended that the number of discharges from department should be applied to calculate the average length of stay and case fatality rate to facilitate horizontal comparisons between departments and fine-tuned hospital management.
Keywords:Number of discharges from department;Average length of stay;Average length of stay in department;Case fatality rate
随着《国务院办公厅关于加强三级公立医院绩效考核工作的意见》（国办发〔2019〕4号）和《国务院办公厅关于推动公立医院高质量发展的意见》（国办发〔2021〕18号）等文件的发布，医院管理模式由粗放式向精细化转变[1-2]。平均住院日（average length of stay，ALOS）和病死率是评价医疗质量和技术水平的重要指标。其中平均住院日=出院者占用总床日数÷出院人数；病死率=死亡人数/出院人数[3]。然而由于转科患者的影响，平均住院日和病死率指标无法真实反映科室的医疗质量和技术水平。因此本研究考虑转科患者的影响，应用出科人次计算科室平均住院日和病死率，促进医院精细化管理。