追踪检查法TracerMethodology从国外到国内

探查系统设计的标准评估点 • 既定的系统要素
质量过程管理
Tracer Methodology 追踪者方法学
Sherry Kaufield
What is Tracer Methodology? 追踪者方法学是什么?
An evaluation method that is an effective way to assess a healthcare organization’s performance of care and the services provided as viewed or experienced by the patient.一个评估方法,通过观察病人的看病经历, 去评估健保组织的照料表现与提供的服务,是一个有效 的方法。
环境安全 Environment of Care
其他 Other
• • • • • •
• • • • • •
• • • • • •
•
• • • • • •
既定的系统要素
• • • • • •
探查系统设计的标准评估机会
评价者B Surveyor 患者 Care Recipient 感染控制 药物管理 数据应用 环境安全
72-year old man presented to ER with chest pain 72 岁的男人用 胸痛苦 送到 ER An electrocardiogram showed signs of sinus tachycardia一个心电图展现了 窦心动过速。 Staff administered aspirin and drew blood职员给予阿斯匹林而且抽血 Mr Chiu: Chiu 先生:
At Cardiac Cath Lab
Discussions cover communication, assessment, performance improvement, and medication management issues.讨论包括沟通，评估，表现进步和药物治疗管理问题 “A little over 2 weeks ago, Mr Chiu came into the ED with chest pains and a history of hypertension and diabetes. What processes were followed for triaging and treating him?” “超过 2个星期以前， Chiu 先生有因胸痛和 高血压和糖尿病到过急诊的历史。 “I see that a cardiac catheterization was necessary; how was informed consent obtained from Mr Chiu?” “ 我 看见心脏的导管 是必需的；如何告知并获得 Chiu 先生同意?" “You’ve said that like many heart attack victims, Mr. Chiu delayed seeking help after experiencing the first symptoms. Has your ED conducted any performance improvement projects to decrease the time it takes to begin treatment?”你说过Chiu先生像许多心脏卒死的人一样症状 初期没有及时寻求帮助.急诊室做了哪些改进工作以缩短开始治疗 的时间.
Step 1
第 1 步骤
Surveyor visits Emergency Department 检查官访视急诊部门
Surveyor speaks with ED Staff
After reviewing the medical record, Surveyor visits ED.在检 查病历卡之后，检查官访视 ED ..
数据使用–数据如何被产生? 数据如何进入 ,移动过,而且离 开医院? 药物治疗管理–如何处理好八个药物治疗管理功能?
Infection Control - How does the organization minimize infection risk?
Medication management – How well are the eight medication management functions handled?
传染控制 - 组织如何将传染危险减到最少?
S a m p l e 实例
Sample Patient Tracer - Hospital Setting 抽取病人样品的追踪者 - 医院设定
Surveyor will identify a patient to trace. May be based on high risk, frequently or infrequently performed procedure or other variable based on hospital-provided data检查官将会识别一位病人追踪。 Patient – Mr. Chiu病人先生Chiu Cardiac-surgery related diagnosis (cardiac bypass surgery)心外科手术相关的诊断 (心外血管搭桥手术)
Emergency Dept – points of discussion
急诊的讨论要点
Triage process 治疗选择程序 Patient assessment病人的评估 Communication prior to patient transfer病人移动 之前的沟通 Medication process, including for high risk concentrated medications and IV solutions药物治 疗程序,为高浓度药物治疗和 静脉输液 Communication needs for elderly patients对老年的 病人的沟通 Competency of medical and nursing staff in emergency care紧急状况照料的医生和看护职员的能力
Surveyor reviews Medical Record 检查官检查病历卡
Antibiotics were begun at the time of surgery外科手术的时候开 始抗生素 Sent to ICU with ventilator which was removed 5 hours later送 到ICU 5 小时之後脱离机械通气 Developed pneumonia within 2 days在 2 天内发生了肺炎 IV antibiotic was changed, but history of smoking has weakened his lungs静脉 抗生素被改变，但是抽烟的历史使他的肺功能 变弱 Placed on ventilator放置机械通气 Wean from ventilator within 6 days在 6 天内脱离机械通气 Received Pulmonary treatment regimen of nebulizer treatments, incentive spirometry, and assisted cough 接受肺的雾化器治疗,刺激 性肺活量测定, 和协助咳嗽 Transferred to a general medical unit with telemetry after 3 days在 3 天之後转移到有遥感勘测的一般的医疗单位 Scheduled to be discharged for continued outpatient rehabilitation制定病人出院后门诊恢复计划
Tracer Methodology追踪者方法学
Tracers provide the methodology to assess an organization’s systems and processes by;追踪者提供方法学以评估医院服务 的组织系统和程序 Following the treatment path an individual patient has taken in the hospital, or Following a process in the hospital from a beginning to an endpoint在病人入院后，跟踪一 位个别的病人在医院的治疗路径从开始到 结束 。
Pulmonary complications (pneumonia)肺的合并症 (肺炎)
Surveyor检查官 Reviews patient record检查病人记录 Notes what services and transfers occurred观察服务 与转运
Surveyor reviews Medical Record检查官检查病历卡
2 Types of Tracers追踪者的两种类型
Patient Tracer – Follows the patient病人的追踪者–跟随病人 System Tracer – Follows the system系统追踪者–跟随系统 Data use – How is information created? How does information come into, move through, and leave the hospital?
Treated for diabetes and hypertension治疗糖尿病和高血压 Recently quit smoking after 33 years抽烟史33 年,最近戒掉抽烟 Sent to cardiac catheterization lab for an angiogram, which revealed 5 blockages 送到心脏的导管室做血管造影, 显示了 5个阻塞 Put on IV heparin, nitroglycerin and beta-blocker静脉使用 肝素，硝酸甘油和 贝它-阻制剂 Transferred to ICU转移到 ICU Hypertension was an issue. So medications were adjusted to lower his blood pressure高血压是一个问题,降血压治疗. Surgery for a coronary artery bypass graft was scheduled for the next morning准备次日早晨实施外科冠状的动脉搭桥手术
Infection Control
Medication Management
Data Use
Environment of Care
其他
Other
A
评价者A Surveyor
百度文库
• • • • • •
个案追踪的标准评估机会
• • • • • •
• • • • • •
• • • • • •
• • • • • •
药物管理 Medication Management
数据应用 Data Use
环境安全 Environment of Care
其他 Other
个案追踪的标准评估机会
系统追踪
评价者
Surveyor
感染控制 Infection Control
药物管理 Medication Management
数据应用 Data Use
追踪检查法
Tracer Methodology
从国外到国内
中国医院协会评价评估部
王吉善
联系方式:电子信箱:wangjishan@vip.sina.com
顺藤摸瓜与追踪检查
顺着瓜藤蔓去找西瓜。 比喻按照某个线索查究事情。
个案追踪
患者
Care Recipient
A
评价者A
Surveyor
感染控制 Infection Control