TAP CHl Y HOC VIET NAM TAP 459 - THANG 10 - SO 1 - 2017 TAI LIEU THAIVI KHAO
1. Bo Y t&, Trung tSm Truyen thong GDSK TU" - Ban tin De an 1816 thang 7, thang 8, thang 9, thang 10 nam 2009.
2. Nghj quyet 46 - NQ/TU ngay 23/2/2005 eiia Bg Chinh tri ve cong tac bao ve, cham soc va nang cao sire khde ciia nhSn dan trong tinh hinh mcli.
3. Bo Y te, 2010, Cong van ^ 2950/BrT-KCB ngay 10/05/2010 ve viec hudng dan xSy duhg quy tnnh diuyoi giao ky thuat y te trong thut hien fie an 1816 4. Cue puan ly Kham chu'a b^nh. Bo Y te, 2012, Tai lieu Hoi thao tang cUdng thUc hieii De an Benh
vien ve tinh va De an 1816 nham gop phan giam tai benh vien
a. Quyet dinh so 30/2001/QD - TTg ngay 22/01/2005 ciia Thii tu'dng Chinh phii phe duyet Quy hoach phat trien mang ludi kham, chGS benh den narh 2010 va tam nhin den nam 2020.
6. Quyet djnh so 1816/QD-BYT( ngay 26/5/2008 cua Bo trirdn^ Bo Y te ve viec phe duyet De an "CiT can bo chyyen mon luan phien tir b^nh vien tuyen tren ve ho trO cac benh vien tuyen dUdi nham nang cao chat lu'dng kham, cHiJa benh".
7. Quyet djnh so •4028yQp-BYT n^ay 20/10/2010 eua Bo trVdng Bg Y te ve viec phan cong chi dao tuyen trong Itnh vi/c kham, chUa benh.
THai GIAN CH(y KHAM TAI KHOA KHAM BENH,
BENH VIEN Tir SaN, TINH BAC NINH NAM 2017
T O M TAT
Nghien edu mo ta eSt ngang dUpc thue hien tren 2102 nguicJi benh nham mo ta thdi gian chd kham ciia ngudi b|nh tai^^khoa kham benh, benh vien Da Khoa TU Sdiv tinh Bac Ninh nam 2017. Ket qua nghien ciTu cho thay tSng thdi gian chd kham trung binh la 118,16 phiit (trung vj la 152 phiit). Thdi gian chd kham ciia ngu'di chi kham lam sang dPn thuan la it nhat (73,88 phut), bang khoang 1/2 so vdi nhdm ngUdi benh kham lam sang+lCLS (149,5 phut) va bang khoang 1/3 so v6i nhom kham lam sang ket hop vdi td 2 CIS tre! len (190,5 phut). Trong tiihg bu'dc kham chiia benh cu the, thdi gian chd thi/c hien cac Cl^ la lau nhat (62,72 phiit) trong do dac biet la tai phong xet nghiem thdi gian chd lay ket qua la 68,8 phut.
td khoa: Thd\ gian chd kham, khoa kham benh, benh vien Da khoa TiT Sdn
SUIVIMARY
MEDICAL EXAMINAHON TEI^IE OF PATIENTS AT OUTPATIENr DEPARTMENT OF "TU SON DISTRICT
HOSPHAL, BAC NINH PROVINCE I N 2017 A cross-seebonal descriptive study was conducted on 2102 patients to assess the total time patients spent during their medical examinations at the Outpatient Department of Tu Son distnet hospital, Bac Ninh province in 2017. The result showed that the average total time of patients spent at department is 118.16 minutes (median=152 minutes). According to the number of medical techniques, the examination
^Benh vien Da Khoa TdSdn, tinh Bac Ninh,
^Benh Vien Mat TW
^fw&ng Dalhgc YHa Ngi ''Trudng Dai hgc Y tecong cong Ha Ngi Chiu trach nhiem chi'nh: Ngo Thi Hai Yen Email: [email protected] Ngay nhan bai: 28.7.2017 Ngay phan bien khoa hoe: 5.9.2017 Ngay duyet bai: 14,9.2017
Ngo Thi Hai Yen', Tr3n Thu Ha%
Hoang IMinh Hang^ Nguyen Thi Thuy Nga'*
time of patients who was examined using only the simple examination service was the shortest with 73,88 minutes or about VJ the time of patients who was examined more than one method of examinations. The patients who were examined by the simple examination plus two or more the two addlbonal medical methods took the longest examination time, with 190.5 minutes. In each medical examination step, the average time of waiting for the subclinical results was longer (mean=62.74 minutes), especially the waiting time at Laboratory department quite long (mean=68.8 minuts).
Keyword: Examinabon time, Patients, Tu Son district Hospital
I.OyjkTVANOE
Thdi gian chd kham la mot trong nhu'ng yeu to quan trong anh hu'dng tdi s i / hai long eiia ngu'di benh khi sd dung dich vu kham chu'a benh (KCB). Hien nay nhieu benh vien (BV) tir Trung u'dng den cd sd xuat hien tinh trang qua tai trong KCB. Qua phan anh ciia NB, cd quan truyen thong va ket qua kiem tra ciia Bp Y te tai khoa Kham benh d nhieu BV eho thay tlnh trang Chen lan khi lam thii tuc, ndi ngoi chd kham bat tien, ndng ni/c, thdi gian chd kham keo dai (vdi niiu'ng benh ddn thuan khong phai lam XN cung mat tir 6-8 tieng), chat lu'dng dich vu y te khong dap irng kip nhu cau ciia NB [ 1 ] . Vdi phu'dng cham lay ngu'di benh (NB) lam trung tam, nganh y te da cd nhieu de an, giai phap giam tiidi gian chd kham dap u'ng si/ hai long cua NB.
Tiii/c hien chii tru'dng khuyen khich cac BV nang cao QLCL cua Bp Y te, Uy ban nhan dan tinh Bac Ninh va Sd Y te tinh Bac Ninh, tir nam 2014 BV_ Da khoa (BVDK) TiT Sdn da da chii trpng trien khai edng tae quan ly chat lu'dng, cai tao nang cap ed sd ha tang trang thiet bj, cong
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017
buol chieu, thdi diem NB dang ki kham tn/dc 7:00 va sau 16:30.
2.2 Phu'dng phap nghien cii'u: Nghien cii^
md ta cat ngang
Thdi gian nghiSn cii'u: td thang 3/2017 den
thang 6/2017. * Dia diem nghien edu: Khoa Kham benh va
khoa Chan doan hinh anh - XN, BV DK Tir Sdn
tinh Bac Ninh. I|
Cd miu: So lieu thdi gian chd kham eiia NS' thi/c hien quy trinh kham benh tai khoa Kham benh tren phan mem quan ly BV id thii' hai den t h i i sau trong mdt tuan eiia thang 3 nam 2017.
Ap dung cong thu'c tinh c9 mau u'dc lu'dng mot gia tri trung binh
.2 . 2
K - Z,
nghe thong tin va cai tien rut ngan quy trinh kham benh ngoal trii tu" 8 bu'dc xuong edn 4 bu'dc giam phien ha cho NB. Tuy nhien tir thang 1 nam 2016, luat BHYT cho phep kham thong tuyen, nen NB de.n kham tai BVDK TiT Sdn tang eao, trung binh 700-800 lu'dt ngu'dl/ngay, tang 30% so vdi nam 2015 [2]. Tlnh trang NB phan nan phai chd kham lau do qua dong NB chd kham vao buol sang, gay iin tae cue bp khau chd bac sT kham chi djnh CLS va chd d bp phan XN.
Tai thdi diem nay, mot nghien cu'u ve thdi gian chd kham benh ciia NB tai khoa Kham benh, BVDK Tu" Sdn la rat can thiet cho edng tae quan ly chat lUdng kham benh eiia BV. Chung toi tien hanh nghien edu giai doan 1 vdi muc tieu
"flo iddng thdi gian chd kham benh cua NB tai khoa Kham bSnh"de td do gliip de ra nhii'ng eai tien phii hdp nham giam thdi gian chd kham trong giai doan tiep theo.
II. 001 TU'ONG VA PHU'aNG PHAP NGHIEN COTJ 2.1 D6i tu'dng nghien cihi: Ho sd thdi gian chd kham dien tu" ciia tat ca NB kham benh ngoai tru tren may tinh eai dat phan mem quan lyBV eiia BVDK Tir Sdn.
TiSu chuan loai trd: Ho sd thdi gian chd kham dien tu" ciia NB kham phdng kham tu' nguyen, kham siTc khde theo yeu cau, NB nang, NB triing ten va triing ma kham benh trong ngay, NB thieu thdi diem nhan thuoc trong ngay hoac thdi diem dang ki kham benh/tra ket qua CLS buol sang nhutig cd thdi diem kham benh/dpc ket qua CLS va cho chi djnh dieu tri III. KET QUA NGHIEN CCrU
3.1. Thdi gian (TG) chd kham benh trung binh va mot sdyeu to'lien quan Bang 3.1. Thdi gian (TG) chd kham benh trung binh dcac vi tri (ddn vjiphut)
1
• a l l - ,2 Trong do: Lay ^ = ^ 4 7 ^ 6 = 105 (Theo nghien ciTu eua Le Thanh Chien)[3]. Chpn a = COS, E=0.025 du'dc c5 mau tdi thieu can nghien cijfu n=1110. Sd lu'dng NB chung toi lay trong thang 3/2017 la 2102 NB thda man tieu chuan lLi:a chpn, dil ldn, dam bao tinh dai dien va co kha nang thi/c thi.
Van de dao ddc eda nghiSn edu: Nghien eiru du'dc phep ciia Ban giam ddc va lanh dao eac khoa phdng ciia BVDK Tir Sdn. Thong tin tliu du'dc chi phuc vu cho muc dich nghien ciTu va du'dc bao mat.
Tdng TG chd
Thtf j gian trung binh ± SD ( n )
Trung Nhanh nhat
Liu
nhat
118,16 ± 81,71(2102) 152
TG chd kham benh lan 1
Trong do
26,09 ± 28,26(2102)
TG kham, ehi djnh2,35 ± 1,19(2102)
TG chd CLS chung
62,72 ± 46,20(1117)
TG chd lay benh pham XNTG chd chup"XCr TG chd sieu am TG chd lay ket qua XN
Chi tiet
24,39 ± 13,76(251)
25,02 ± 16,7(219) 26,06 ± 17,96(80) 68,80 ± 27,75(251)
TG chd kham benh lan 246,75 ±44,70(1117)
TG chd thanh toan, lay the10,55 ± 17,63(2102)
TG chd lay thuoc21,06 ± 26,36(2102)
Bang 3.1 cho thay tong thdi gian chd kham eua NB la 118,16 phut, lau nhat la thdi gian chd thut hien cac CLS (62,74 phut) trong dd dac biet tai phong xet nghiem thdi gian chd lay ket qua la 68^8 phut; giam dan la thdi gian chd kham lan 2 (46,75 phiit), ngan nhat la thdi gian chd thanh toan lay the (10,55 phiit), thdi gian kham ehi dinh la 2,35 phut.
TAP CHi Y HOC VI&T NAM TAP 459 - THANG 10 - S O I -2017
Bang 3.2. Thdi gian chd kham benh trung binh theo cac mui gld dang ky kham cua NB (dan vhphut)
Mui gid dang ki l<iiam benh Tir 07:00 den 08:00 Tif 08:01 den 09:00 Tir 09:01 den 10:00 Tir 10:01 den 11:30 Tir 13:00 den 15:00 Tir 15:01 den 16:30
T y l e (»/o) 29,3 16,3 10,5 4,2 33,4 6,3
Thdi gian trung binh ± SD ( n )
181,90 ± 70,77(616) 134,21 ± 84,57(343) 109,95 ± 86,75(220) 114,27 ± 99,9(89) 71,92 ± 38,30(702) 41,18 ± 20,75(132)
Trung vj 190 119 85,5 69 64,5
37 Nhanh
nhat 19 13 13 17 12 12
Lau nhat 399 398 385 333 216 99 Nhin vao bang 3.4 chung ta thay: Vao budi sang, ngu'di benh den dang ky kham benh nhieu nhat vao khoang thdi gian tir 07:00 den 09:00 chiem 45,6%; rat it ngu'di benh (4,2%) dang ky kham benh vao khoang thdi gian tir 10:01 den 11:30. Vao buol chieu, ngu'di benh den dang ky kham benh ddng (33,4%) vao khoang thdi gian tir 13:00 den 15:00. Dieu do cung tu'dng uTng tai miii gld dang ki kham benh tir 07:00 den 08:00 cd thdi gian chd kham trung binh dai nhat (181,90 phut). Thdi gian chd kham ngan nhat vao buoi chieu miii gid tir 15:01 den 16:30 (41,18 phiit).
3.2 Thdi gian chd kham benh trung binh th^ nhdm ngu'di benh 149.5 -88.=64
a C " = 3 S ^ )
Bleu do 3.1. Thdi gian chd kham benh theo nhom NB (ddn vhphut).
Theo phan nhdm ngu'di benh, thdi gian chd kham ciia ngu'di chi kham lam sang ddn thuan la it nhat (73,88 phut), bang khoang V2 so vdi nhom ngu'di benh kham lam sang+lCLS (149,5 phut) va bang khoang 1/3 so vdi nhdm kham lam sang ket hdp vdi tiT 2 CLS trd len (190,5 phiit).
ciia Cue Kham chu^ benh - Bd Y te (40,1 phiit;
IV. BAN LUiQiN
Tong thdi gian chd kham trung binh ciia NB la 118,16 phut. Ket qua nay cao hdn so vdi nghien ciTu eiia Nguyen Thi Thu Ha (2014) tai benh vien da khoa Ha Ddng (96.91 phiit) [4]. Nhu'ng thap hdn so vdi nghien ciTu cua Tran Thj Quynh Hu'dng (2014) tai benh vien da khoa Thong nhat tinh Dong Nai (i50.4 phut) [5]. Vay cd the nhan thay so vdi benh vien dong cap NB den kham tai benh vien da khoa Tir Sdn phai chd kham iau hdn phan Idn do keo dai thdi gian chd ddi tai bp phan xet nghiem, con vdi tuyen tinh t / le NB den kh^m dong hdn, cac chi djnh CLS nhieu hdn nen thdi gian chd ddi ciia NB dai hdn la phii hdp.
Theo phan nhdm NB, thdi gian chd kham trung binh tang dan theo sd lu'dng eac ky thuat CLS ma NB thu'c hien (149,50 phut; 190,5 phiit).
Nhdm NB kham ddn thuan ed thdi gian chd kham ngan nhat do NB khong phai chd thdc hien CLS (73,88 phiit). Ket qua thdi gian chd kham eua cae nhdm NB nay cao hdn so vdi thdi gian chd kham tuyen huyen nam 2014 theo bao eao
0,8 phiit; 135,6 phiit) [ 6 ] .
Thdi gian chd kham benh d tirng vj tri cd si/
khac biet. Thdi gian chd kham trung binh lau nhiit la tai khu vUc chd lay ket qua xet nghiem (68,80 phiit), dieu nay cd the ly giai la do sd lu'dng ngUdi benh lam XN-nhieu (trung binh 350 ngu'di benh/ngay) va chii yeu tap trung vao budi sang, trong khi chi cd 02 may in cong suat thap, 01 may sinh hda XL300, may mien dich ban tu"
dpng sau 2 den 3 gid mdi eho ra ket qua nen mdt so phleu XN mac dii cae chi so XN khac da CO ket qua nhuYig phai chd nhu' mdt so ket qua XN ve npi tiet FT3, FT4, TSH... nen nhii'ng benh nhan phai lam cae xet nghiem nay thu'dng cd thdi gian chd ddi lau hdn. Ngoal ra theo quan sat trong mot so thdi diem tai phdng xet nghiem viec duyet ket qua tren may de in hoac tra ket qua chu'a kip thdi. Vi vay, BV TiT Sdn can giam thdi gian chd lay mau va tra ket qua xet nghiem cho ngu'di benh bdi da so hp mac benh tieu du'dng va khong the nhjn an qua lau va chd lay
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017 ket qua. Theo quan sat tai phdng XN: tra ket qua
XN 3 ddt/buol sang vda la nguyen^nhan keo dai thdi gian tra ket qua, viTa gay iin tac eye bp khu vi/c phdng kham, vi khi do mot so lUdngJdn NB se mang ket qua quay lai phdng kham de bac sT eho ehi djnh. NB chd kham lan 2 lau [46,75 phut) do Khoa Kham benh trung binh moi ngay tiep nhan tren 700 NB trong khi ehi ed 12 ban kham ket hdp iin tae cue bp tai cac phdng kham sau eac thdi diem tra l<et qua XN.
Trong nghien ciili eua chung tdi, thdi diem den kham ciJng la yeu to lien quan den thdi gian chd kham. Nhdm doi tu'dng nghien ciTu den kham tru'dc 8 gid cd thdi gian chd trung binh dai nhat (181,9 phut) nhdm doi tu'dng den kham sau 8 gid cd thdi gian chd giam dan. Benh nhan cang den kham muon thi thdi gian chd kham se cang ngan. Quan sat NB di kham sdm mui gld tru'dc 8:00 rat ddng (29,3%) chii yeu la NB man tinh dai thao du'dng, tang huyet ap cd ehi dinh iam XN - CLS nen tam ly di sdm de lay mau lam XN do dd phai chd ddi lau. Nghien ciTu ciia Nguyen Ttii Thao Su'dng (2016) [7] tai benh vien da khoa Thong Nhat cung cho ket qua niiu'ng ngu'di dang ky tru'dc 7: 30 cd tong thdi gian chd ddi lau hdn va nhom benh npi khoa cho thay thdi gian chd ddi lau nhat.
V. KET LUJOLN
Nghien ciTu cho thay mdt so ket qua sau:
Tong thdi gian chd kham trung binh ciia NB la 118,16 phut. Thdi gian chd tai khu vi/c chd thi/e hien CLS la lau nhat (62,74 phiit), dac biet thdi gian chd lay ket qua tai phdng xet nghiem (68,8 phut). Giam dan la thdi gian chd kham benh lan 2 (46,25 phut). Nhdm NB kham lam sang ket hdp tir hai CLS trd len ed thdi gian chd kham trung binh dai nhat (190,5 phut). Thdi gian chd
kham ciia cac nhom NB eao hdn so vdi thdi gian chd kham trung binh tuyen huyen nam 2011 theo bao eao cua Cue Kham chu'a benh, Bp Yte.
KIEN NGH! s Benh vien can tang cu'dng cac giai phapglali
thdi gian chd kham tai khoa Kham benh: Them ban kham, tang cu'dng nhan li/e vao eac gid dian, bo sung may XN, may tinh. Kiioa Chan doan hinh anh- Xet nghiem can du'dc bo tri nhan It/c hdp ly, tang ian suat tra ket qua XN trong ngay, sap xep lai phdng lay benh pham khoa hpc hdn.
TAI UEU T H A M KHAO
1. Cue Quan If Kham chuTa b|nh va B9 Y te (2015), Bao cao cong tac kham chOS benh nSm 2014, ke hoach nam 2015.
2. B|nh vien da khoa Thi x3 Tii Sdn (2016), ^ cao tdng kit cong tac kham chuS benh nam 2016, Benh vien da khoa Thi xa Tir Sdn.
ji. Le Thanh Chien va cong suf (2012), "Kliao sat quy trinh kham ehij^ benh tai khoa Kham benli, benh vien Cap ciTu Trung VircJng" Y hoc TP. Ho Chf Minh, 16(4).
4. Nguyen Thj Thu Ha (2015), Thdi gian s&di^j dfch vu cua ngu&i benh va mot sdyeu to lien quaiiM khoa IQiam benh, benh vien da khoa Ha Bong, h Ngi nam 2014, Luan van thac a y hoe, chuyei nganh Qiian ly benh vien, Tru'dng Oai hoc Y.Ha Noi. j , 3. Tran Thi Quynh Hu'dng va Dd Minh Quanti
(2014), Khao sat thdi gian va chi phi kham b^^
BHYT tai benh vien Da khoa Thong Nhat nam 2014 Benh vien Da khoa Thong Nhat Dong Nai, B i ^ Hoa, truy cap ngay Bltllldtii, tai trang « http://wvtrw.qpsolutions.vn/egi-bin/Document/Khaw satthol gian va chi phi kham 2014 BVT...
6. Cue Quan ly Kham chu'a benh (2015)^ KetquB bt/dc dau thut hien cai each thd tuc hanh chinh trong cai tien guy trinh kham benh.
7. Nguyen Thi Thao Suong (September, 2017], Program in Medical Science, Healthc^
Administration Course, Nagoya University GraduM
School of Medicine. %
MOT SO YEU TO TIEN LirgNG TU" VONG O BENH NHAN VIEM TUY CAP NANG
Ho Yen Ca', Bao Xuan Ctf'
T6IVI TATMyc tieu: Xac djnh tv' le tir vong va cac yeu to tien lUdng tiT vong 6 benh nhan viem tuy cap nang.
•* Tru&ng Dai hgc Y Ha Ngi
^Khoa hoi sdc tfch cut benh vien Bach Mai Chju trach nhiem chinh: Dao Xuan Cd Email: [email protected] Ngay nhan bai: 14.7.2017 Ngay phan bien khoa hoc: 5.9.2017 Ngay duyet bai: 13.9.2017
f>di tu'dng va phUtfng phap nghien cihi: Ngliip.
CLTU hoi cull mo ta tir ho sd benh an luu trU cua m^
benh nhan viem tuy cap nang dieu tn tai khoa Hoi im tich cu'c Bach Mai trong nam 2016. Ket qua: Co Im benh nhannang du'dc dUa vao nghien ciTu, tuoi triW binh la 48,80 ± 13,31 thap nhat la 15 tuoi va cao^n^
la 87 tuoi, trong do t / le nam nhieu hdn so vtJI„iff (80,73% so vdi 19,27%). So benh nhan tir vong la 17j chiem 15,6% (1 tii vong tai vien va 16 nang x i n ^ duoe xac minh tiT vong sau do). Tuoi frung binh # nhom tiT vong va nhom song la 50,18 ± 13,26«
48,54 ± 13,38 (p = 0,332). Ty le nam/nU cua ca m
