无效住院所导致的潜在资源浪费的估算
Estimation of potential waste of resources caused by unnecessary hospitalization

目的 以上海市某三甲医院的妇科为例，从直接经济负担和床位使用效率两方面估算无效住院所导致的资源浪费情况。方法 选择上海市某三甲医院的妇科为样本科室，在2012年上半年入院患者中随机抽取500份病例。采用病例回顾的方式，由1位妇科临床护士应用入院及住院日适当性评价方案(AEP)对样本病例的入院、住院日适宜性作出评价。根据患者支付的住院总费用、床日费用计算无效住院产生的直接经济负担。采用平均住院日、病床周转次数来反映剔除无效住院后床位使用效率的提高程度。结果 妇科的入院无效率为12.40%，住院日无效率为22.93%。剔除无效入院和无效住院日后，可节省近18%的直接经济负担，平均住院日由6.04降低至4.81，床位周转次数由8.06降低至7.06。结论 通过科学合理的措施剔除住院服务提供过程中的无效入院和无效住院日，可以减轻患者看病就医的直接经济负担，并在不影响医疗质量的基础上有效缩短平均住院日。
： Objective To evaluate the waste of resources caused by unnecessary hospitalization from the perspectives of direct economic burdens and bed utilization efficiency according to the data of Department of Gynecology of a tertiary grade A hospital in Shanghai. Methods A total of 500 patients admitted in the first half year of 2012 were randomly selected from inpatients of Department of Gynecology of a tertiary grade A hospital in Shanghai. The retrospective review was adopted and the appropriateness of admissions and hospitalization of selected patients was evaluated by a clinical nurse according to the appropriate evaluation protocol (AEP). The direct economic burden caused by the unnecessary hospitalization was calculated according to the total cost and average daily cost paid by patients. The improvement of bed utilization efficiency after eliminating the unnecessary hospitalization was reflected by the average hospitalization days and bed turnovers. Results The rate of unnecessary admission was 12.40% and the rate of unnecessary hospitalization was 22.93%. After the unnecessary admission and unnecessary hospitalization were eliminated, the direct economic burden could be saved by 18%. Average hospitalization days decreased from 6.04 to 4.81, and bed turnovers decreased from 8.06 to 7.06. Conclusion The elimination of unnecessary admission and unnecessary hospitalization by scientific and appropriate measures during the course of providing the hospitalization service can relieve the direct economic burden of patients and efficiently decrease average hospitalization days without affecting the quality of medical services