非联网医联体门诊转诊入院服务流程再造与应用
The Reconstruction and Application of Transfer Treatment System in Non-Networked Hospital Health Alliance

目的：探索非联网医联体转诊入院服务系统再造与应用的效率性、安全性，满足非联网医联体门诊患者的不同转诊住院需求。方法：建立系统自动转诊及人工换证转诊的流程实施及管理模式，实现不同类别、不同途径的门诊住院转诊的远程签床需求；比较项目实施前后转诊住院患者二次就诊变化以及相应的诊疗费用支出变化；分析统计项目实施前后年度经不同流程实施的转诊结果变化以及远程签床的时效管控效果。结果：项目实施前后经急诊年度下转门诊入院人次占年度总入院人次的21.5%和3.5% (P < 0.01)；项目实施前后经急诊转诊占用急诊床日数分别为1232.5天和158.9天(P < 0.01)；二次就诊花费分别为422,404.5元和89,754.0元(P < 0.01)。项目实施后远程签床有效率达87.8%。结论：该非联网医联体转诊入院服务流程能较好地保证转诊住院的医疗机构患者的有序流动、减少因二次就诊产生的相关医疗费用，更好地保证等待入院患者的及时住院就医、提高转诊入院患者就医体验，提高医院急诊及住院医疗资源的利用度、较有效地提高转诊入院服务效率。
Objective: To explore the efficacy and safety of reconstruction and application for the transfer treatment system in non-networked hospital health alliance, and to meet the needs of different referral hospital of outpatients in non-networked hospital health alliance. Methods: The implementation and management modes of systemic automobile transfer and manual transfer treatment were established in order to meet the requirements of remote admission for outpatients’ referrals of various types and routes. The changes of two visits of inpatients before and after the implementation of the project and the clinical costs of medical treatment were compared. The changes in transfer treatment performed by different processes before and after the project and the effect of time-limited control were analyzed. Results: The proportions of hospital admissions from the emergency department to outpatient department before and after the project implementation were 21.5% and 3.5% in all inpatients per year, respectively (P < 0.01). The duration of using the emergency bed for emergent referral was 1232.5 days and 158.9 days before and after the project, respectively (P < 0.01). The cost of twice visits was 422,405.5 yuan and 89,754.0 yuan, respectively (P < 0.01). The effective rate of remote bed signing was 87.8% after the implementation of the project. Conclusion: The non-networked hospital health alliance transfer treatment service process could ensure the flow of patients orderly, and reduce the related medical expenses caused by twice hospital visits. Meanwhile, the process could ensure the timely hospitalization for waiting outpatients, and improve the medical experience, the utilization of hospital emergency and medical resources, and the referral and admission effectively.