【作者】 吴建荣；

【导师】 杜亚平；

【作者基本信息】 浙江大学 ， 公共卫生（专业学位）， 2017， 硕士

【摘要】 目的通过对某县级医院夜间急诊检验特征的分析,了解该地区夜间急诊检验患者就诊特点,检验标本数量、检验项目的分布特征,检验患者平均费用以及检验结果报告时间,进而分析其可能的原因并得出相关结论,为夜间急诊检验工作人员的合理安排、检测仪器的配置、相关试剂及物资的储存提供科学的依据,同时也为急诊检验科的科学管理提供相应的数据支持,并为急诊科医生和医院管理者提供相应参考。方法回顾性分析某县级医院(三级乙等)2015年1月-12月夜间17:31至次日7:30急诊检验患者的资料,包括性别、年龄、就诊科室、初步诊断、检测项目等。从医院数据数库中按条件筛选出相应的数据并导入Excel中,应用SPSS19.0软件进行统计分析,并制作相应的图表。结果1、夜间急诊检验患者特点2015年夜间急诊检验患者共有30306人,其中男性14891人,女性共15415人,男性:女性=1:1.04。年龄最小的患者为15天,最大的为100岁。0～10岁年龄段的患者最多有10113人,占检验总人数的33.37%,80岁以上患者人数最少共684人,占总数的2.25%。18:31～19:30是夜间检验患者人数最多的时段,共有5026人,占总数的16.58%,随后患者人数逐渐下降,凌晨4:31～5:30为检验患者人数最少516人,占1.70%。检验患者最多的月份是七月共有3860人,占总人数的12.74%;人数最少的是九月为2009人,占6.63%。病人以急诊内科和儿科患者为主,分别为16356人和10409人,分别占总检验人数的53.97%和34.35%。2、夜间急诊检验的标本量30306名患者共有标本48549份,18:31～19:30是标本量最多的时段共有7809份,占总标本量的16.08%,凌晨4:31～5:30为检验标本量最少924份,占1.90%。七月是标本量最多共有6473份,占13.33%,而十一月是标本量最少共有3296份,占标本总数6.79%。标本量基本上随着检验患者人数的变化而变化。血常规是检测最多的项目共有27229份,占标本总量的56.09%,其次是生化标本共12691份,占26.14%,其中最多的一个检测项目是心肌酶谱,共有7888份标本,占生化标本总数的62.15%。3、急诊患者检验费用急诊检验患者人均检验费用69.82元,每份标本的平均费用为43.55元。男性患者平均检验费用为70.27元,女性为69.40元,两者差异无统计学义。男性每份标本平均检验费用为44.25元,女性为42.95元,两者差异有统计学意义。十岁以内检验患者的平均检验费用和每份标本的平均检验费用最低,分别为34.05元和31.38元。急诊内科人均检验费用和每份标本的平均费用最高,分别为94.07元和49.33元;而急诊儿科急诊的人均费用最低为33.79元,急诊妇产科的每份标本的平均费用最低为25.86元。4、检验结果回报时间患者标本检验结果回报中,血常规标本检验结果报告时间平均为15.15分,标本在群率为99.03%;生化标本检验结果报告时间平均为45.25分,在群率为98.02%,凝血标本检验结果报告时间平均为44.31分,在群率为99.33%。结论1、该地区夜间急诊检验患者十岁以下人数最多。检验患者人数主要集中在五点半至十点半,不同月份、不同季节患者人数的分布有统计学差异。检验患者主要来自急诊内科和急诊儿科,而且急诊内科检验人数为最多。2、标本量基本上随着检验患者人数的变化。检验项目主要以血常规和生化为主,而生化项目又以心肌酶谱最多。3、不同年龄段患者的检验费用不同。不同月份、不同科室、不同诊断的平均检验费用和每份标本平均费用有差异。4、夜间急诊检验结果报告的平均时间相对较短,血常规、生化、凝血标本的在群率比较高,检验结果报告相对比较及时。更多还原

【Abstract】 ObjectiveAccording to the analysis for characteristics of night emergency tests in a county-level hospital,we attain the comprehensive understanding of relative features about patients and inspection items of night emergency.Furthermore,we explore possible causes and draw correspondent conclusions,which not only offer a scientific basis for reasonable arrangement of night emergency staff,configuration of testing instruments and storage of materials and reagents,but also provide emergency physicians and hospital administrators with a reference on effective management.MethodsThe data for emergency test patients was retrospectively analyzed from January to December 2015,between 05:31pm to 7:30 am in a county-level hospital(Third grade b level hospital),including gender,age,emergency department,preliminary diagnosis,the test items,etc.We filtered out the corresponding data from the hospital database,imported them into Excel and then analyzed them with SPSS 19.0 statistical software together with making relevant charts.Results1、Characteristics of night emergency test patientsThere were 30306 test patients in 2015,including 14891 males and 15415 females.The Mal-Female ratio was 1:1.04.The youngest patient was 15 days old and the oldest was 100 years old.First,according to distribution of the quantity of patients in different age groups,the largest is between 0～10 year-old that 10113 patients corresponding to 33.37%of total and the smallest is over 80 year-old that 684 patients accounting for 2.25%.Then for time interval,the busiest time was between 18:31 to 19:30,with a total of 5026 patients that accounting for 16.59%.After that it followed by the gradual decline in the number of patients.The relatively vacant time was between 4:31 to 5:30 when 516 patients that was made up 1.70%of total.Additionally,we received the largest number of patients tested in July which was totally 3860 patients that 12.74%of total,and the smallest number of patients in September,which 2009 patients that accounts for 6.63%.Last but not least,emergency cases were mainly internal medicine patients and pediatric patients,16356 and 10409 patients,accounting for 53.97%and 34.35%of the total number respectively.2.characteristics of night emergency test specimenWe acquired 48459 samples in total from the 30306 patients,and the sample size would change with the amount of patients tested.First,according to time interval,the largest quantity of specimens tested was between 18:31 pm to 19:30 pm that 7809 specimens accounting for 16.09%of the total,while the smallest one was between 4:31 am to 5:30 am with 924 specimens that corresponding to 1.90%of total.Then for months,6473 samples tested in July which was maximum proportion 13.33%of total but 3296 samples tested in September which was minimum proportion 6.79%of total.Finally,about the distribution of various inspection types,blood routine was the most widely detected project with 27229 samples that account for 56.09%of the total number of samples,followed by 12691 biochemical samples,accounting for 26.14%.Additionally,Myocardial enzyme is the most widely tested item in biochemical samples,which had 7888 samples,accounting for 62.15%of the total number of biochemical samples.3.Emergency patients test costThe cost per person in the emergency test was 69.82 yuan,and the average charge for each sample was 43.55 yuan.The average cost of male patients was 70.27 yuan,and that of female was 69.40 yuan.There was no significant difference between the two groups.However,the Gender difference of average cost per specimen was statistically significant that 44.25 yuan for males and 42.95 yuan for females.For those under ten years old,the average fee for each patient and each specimen were the lowest,34.05 yuan and 31.38 yuan respectively.The highest average cost of per patient and sample was from the emergency internal medicine,64.05 yuan and 49.31 yuan respectively.Moreover,the lowest per patient was from the emergency pediatrics,33.79 yuan for each and the lowest per sample was 25.86 yuan in Gynecology Department.4.Turn around time of emergency testAmong the average report time of patient specimens,15.15 minutes for blood routine specimens whose pass rate was 99.03%,45.25 minutes for biochemical specimens with the qualified rate of 98.41%and 44.31 minutes for coagulant specimen according to 99.33%pass rate.Conclusion1.Among the night emergency patients in the region,the largest age group was under ten and most of them were male patients.The busiest time interval for medical tests was between 5:30 pm and 10:30 pm.Moreover,there were significant differences in the number of patients in different months and seasons.Additionally,the enormous number of patients was mainly from emergency internal medicine and emergency pediatrics especially for emergency internal medicine which has the largest quantity of patients tested.2.The quantity of specimens varies with the number of test patients.The main items of the samples were blood routine and biochemistry,additionally,myocardial enzyme is the most frequently tested biochemical project.3.Patients in various age groups have different per capita costs.The average test fee for each patient and each sample varies in different months,departments and diagnoses.4.The average report time of emergency test results is relatively short.The passing rates of blood routine,biochemical and coagulation samples are relatively high.Thus,the test results always came in time.更多还原