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病案质量是考核各级医院工作质量的主要内容之一。如何提高病案质量是各级医院质量管理中的重大课题。笔者根据对一家三级甲等综合医院和六家二级甲等综合医院百项指标考评结果及在处理医疗纠纷中的经验教训和多年的工作体会,依据自己的所见所闻,所思所想,就当前各级医院病案质量控制存在的共性问题,谈谈自己的看法和建议。 一、质控方法落后
The quality of medical records is one of the main contents of assessing the quality of work at all levels of hospitals. How to improve the quality of medical records is a major issue in the quality management of hospitals at all levels. Based on the results of the evaluation of a hundred indicators in a three-level general hospital and six secondary general hospitals, as well as the experience and lessons learned in dealing with medical disputes and many years of work experience, the authors based on what they saw and heard. I would like to talk about my own opinions and suggestions on the common problems existing in the quality control of medical records at all levels of hospitals. First, the quality control method is behind