DRG在医院管理中的应用.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,DRG,在医院管理中的应用,北京大学人民医院 赵越,目录,第一部分,公立医院改革形势,第二部分,DRG,的管理工具在医院的应用,第三部分,DRG,的资金支持功能,临床路径,2,医改目的,解决医疗资源分布不均的矛盾,解决国家投入和医保筹资与医疗花费之间的矛盾,目录,第一部分,公立医院改革形势,第二部分,DRG,的管理工具在医院的应用,第三部分,DRG,的资金支持功能,临床路径,4,DRG,的管理工具在医院的应用,一、用于提高病房效率,二、用于医疗职称评定,三、用于提高人员使用效率,准确,与效率密切相,关,易得,有效,u,E=W/T,u,W=CMI,N,u,E=W/B/T=CMI,N/B/T,科别,科室,1,科室,2,科室,3,科室,4,科室,5,科室,6,科室,7,科室,8,科室,9,科室,10,科室,11,科室,12,科室,13,科室,14,科室,15,科室,16,科室,17,科室,18,科室,19,科室,20,科室,21,科室,22,科室,23,科室,24,科室,25,科室,26,科室,27,科室,28,科室,29,科室,30,科室,31,科室,32,科室,33,科室,34,科室,35,总计,2016,上半,年,42.0,38.8,34.4,29.6,29.1,29.0,25.2,23.423.2,22.9,21.8,21.1,20.9,20.4,19.7,19.6,19.2,19.0,18.3,18.2,17.7,17.1,16.2,14.5,13.8,12.7,11.9,11.8,11.5,10.8,10.5,9.7,8.8,8.6,5.4,20.2,2015,上半,年,40.4,11.6,25.7,22.5,24.8,25.5,20.7,19.6,21.0,18.4,21.1,18.5,19.8,17.2,17.4,15.7,17.1,18.0,22.5,15.8,16.1,14.1,12.1,14.0,13.2,12.6,8.1,11.4,7.9,10.9,10.3,7.1,8.5,8.2,6.9,17.3,同比,增长,(%),3.8,233.,3,34.1,31.5,17.3,13.7,21.7,19.7,10.3,24.3,3.6,14.4,5.4,18.8,13.2,24.9,12.6,5.6,18.4,14.7,10.0,20.9,34.2,3.6,5.1,0.7,46.7,3.6,45.0,0.7,1.6,36.1,3.6,4.7,22.0,16.7,2015,上半年、,2016,上半年科室单床工作量对比,2016,上半年均值：,20.2,排名,科别,2016,年上半,年出院人次,入组人次,（,2016,上半年,）,入组人次,（,2015,上半年入组人次 同,比增长,(%),单床工作量,（,2016,上半年,）,单床工作量,（,2015,上半年,）,单床工作量,同比增长,(%),CMI(2016,上,半年）,CMI(2015,上,半年）,1,科室,1,1295,1293,1243,4.02,41.99,40.44,3.83,1.85,1.85,2,科室,2,103,103,78,32.05,38.76,11.63,233.30,1.51,1.19,3,科室,3,1157,1149,910,26.26,34.39,25.65,34.07,1.59,1.49,4,科室,4,324,320,254,25.98,29.60,22.51,31.51,3.61,3.46,5,科室,5,3552,3552,2980,19.19,29.10,24.80,17.33,0.49,0.50,6,科室,6,1141,1140,1012,12.65,28.96,25.48,13.66,1.57,1.56,7,科室,7,2520,2519,2148,17.27,25.24,20.74,21.70,0.66,0.64,8,科室,8,243,241,215,12.09,23.41,19.56,19.66,2.04,1.91,9,科室,9,485,482,459,5.01,23.22,21.04,10.34,1.44,1.38,10,科室,10,2258,2257,1881,19.99,22.86,18.39,24.29,1.34,1.38,11,科室,11,961,958,946,1.27,21.83,21.08,3.57,1.14,1.11,2015,年上半年、,2016,年上半年单床工作量统计,12,科室,12,1884,1884,1451,29.84,21.10,18.45,14.38,0.54,0.61,13,科室,13,1700,1691,1454,16.30,20.92,19.84,5.42,0.96,1.06,14,科室,14,1451,1451,1189,22.04,20.45,17.22,18.75,1.03,1.0615,科室,15,403,403,381,5.77,19.68,17.39,13.15,2.05,1.92,16,科室,16,5324,5170,4616,12.00,19.61,15.70,24.91,1.23,1.10,17,科室,17,768,767,665,15.34,19.19,17.05,12.58,1.48,1.53,18,科室,18,1618,1617,1568,3.13,18.97,17.97,5.58,0.59,0.57,19,科室,19,715,715,915,-21.86,18.32,22.45,-18.40,0.41,0.39,20,科室,20,831,831,849,-2.12,18.15,15.83,14.69,0.79,0.75,21,科室,21,654,654,554,18.05,17.73,16.11,10.05,0.73,0.78,22,科室,22,2789,2789,2441,14.26,17.06,14.11,20.87,0.67,0.64,23,科室,23,793,793,594,33.50,16.17,12.05,34.23,0.75,0.75,24,科室,24,59,59,119,-50.42,14.51,14.01,3.57,0.98,0.94,25,科室,25,827,826,771,7.13,13.84,13.16,5.13,0.85,0.87,26,科室,26,1422,1412,1462,-3.42,12.73,12.64,0.70,0.87,0.84,27,科室,27,428,426,299,42.47,11.93,8.13,46.74,0.98,1.06,28,科室,28,416,415,392,5.87,11.78,11.37,3.60,0.88,0.90,29,科室,29,222,214,158,35.44,11.49,7.92,45.04,1.72,1.60,30,科室,30,642,634,623,1.77,10.81,10.89,-0.70,0.96,0.98,31,科室,31,450,450,435,3.45,10.51,10.34,1.62,0.70,0.71,32,科室,32,72,72,38,89.47,9.72,7.14,36.13,0.81,1.13,33,科室,33,196,196,189,3.70,8.75,8.45,3.55,0.94,0.94,34,科室,34,277,277,268,3.36,8.57,8.19,4.67,0.87,0.86,35,科室,35,78,77,129,-40.31,5.37,6.88,-22.01,0.70,0.75,总计,38058,37837,33686,12.32,20.23,17.34,16.68,1.00,0.98,u,目的：提高病房效率,u,目标：,2016,年实现病房单床工作量达,45,u,步骤,1,：培训,u,步骤,2,：科室间合作，减少空床率,u,步骤,3,：科室内部调整，,CMI,不变或升高的前提下，增加出院病人数,u,步骤,4,：与绩效挂钩,1,、,DRG,用于提高病房效率,步骤,1,：培训,病案统计室培训医生准确填写首页,院周会上讲解使用率、平均住院日、同一病种平均住院日、,DRG,同病组平均住院日、单床效率指标的意义,讲解如何提高单床效率,增加单床产出,单床效率就是单位时间内的单床工作量，就是单床产出,空床：床位产出为零；,该出院不出院：单床产出低下,床位周转慢：单床产出低下,收轻病人：单床产出低下减少空床率,提供床位科室降低单床效率分母,接受床位科室增加单床效率分子,两科室要制定相应流程,两科室要保证病人安全,床位使用率低于,75%,，低于部分划归医院的综合病房,增加床位周转,CMI,不变或增加,增加周末收治病人数量,缩短同病种患者住院时间,利用好床位,步骤,4,：与绩效挂钩,评估科室各专业组管理病人效率,评估条件,各专业组,床位相同,各专业组,床位不同,只比较工作量，专业组所有,出院病人疾病难度之和,算单床效率，专业组所有出院病人疾,病难度之和,/,专业组床位数,步骤,4,：与绩效挂钩,评估科室每位医生管理病人效率,评估条件,医生管理,床位相同,医生管理,床位不同,只比较工作量：每位医生所有,出院病人疾病难度之和,算单床效率：每位医生所有出院病人,疾病难度之和,/,医生管理床位数,2016,年,10,月单床工作量,排名,出院科室,出院人数,入组人数,工作量,床位数,单床工作,量,CMI(,平均,疾病难易,度）,2016,年,9,月,单床工作,量,2016,年,9,月,CMI,床位说明,1,科室,1,25,25,34.57,4,8.64,1.38,9.62,1.42,2,科室,2,219,217,411.72,57,7.22,1.90,5.57,1.71,3,科室,3,183,181,272.59,53,5.14,1.51,5.81,1.49,4,科室,4,52,52,147.65,30,4.92,2.84,3.85,3.42,30-9,（借骨肿瘤科）,+,心外,监护,9,5,科室,5,193,189,295.16,62,4.76,1.56,5.65,1.54,54+,海淀,8,6,科室,6,509,508,251.71,60,4.20,0.50,4.54,0.52,7,科室,7,333,332,192.57,48,4.01,0.58,3.88,0.54,8,科室,8,404,397,248.27,66,3.76,0.63,4.51,0.71,30+,海淀,36,9,科室,9,347,344,486.71,132,3.69,1.41,4.43,1.27,50+42+CCU21+19,10,科室,10,245,240,265.58,73,3.64,1.11,3.38,0.98,41+,白塔寺,32,11,科室,11,65,65,152.63,42,3.63,2.35,3.49,2.19,12,科室,12,28,28,56.55,10,3.53,2.02,4.38,1.40,重症监护,8+,急诊科第二监护,室,2,13,科室,13,79,79,105.58,30,3.52,1.34,4.42,1.43,14,科室,14,156,156,125.3,36,3.48,0.80,3.44,0.77,15,科室,15,153,152,173.16,50,3.46,1.14,4.10,1.14,16,科室,16,211,205,236.29,70,3.38,1.15,3.67,0.99,53+,白塔寺,17,17,科室,17,33,32,68.21,21,3.25,2.13,2.83,1.60,18,科室,18,281,280,159.9,50,3.20,0.57,3.75,0.62,42+,海淀,8,19,科室,19,833,798,962.17,323,2.98,1.21,3.60,1.22,西直门,156+,白塔寺,35+,海淀,132,20,科室,20,73,73,73.65,25,2.95,1.01,2.42,0.86,31-6,（,6,张借耳鼻喉科）,21,科室,21,123,120,171.61,59,2.91,1.43,4.00,1.54,22,科室,22,108,105,45.26,16,2.83,0.43,3.05,0.42,23,科室,23,10,10,10.71,4,2.68,1.07,3.03,0.93,24,科室,24,412,409,277.88,105,2.65,0.68,2.97,0.62,59+,白塔寺,20+18+,海淀,8,25,科室,25,123,123,97.51,37,2.64,0.79,3.22,0.80,26,科室,26,18,18,15.06,6,2.51,0.84,3.24,0.88,27,科室,27,90,89,66.91,27,2.48,0.75,2.46,0.79,30-3,28,科室,28,269,259,219.13,90,2.43,0.85,2.66,0.88,57+,白塔寺,23+,海淀,10,29,科室,29,130,129,108.11,51,2.12,0.84,2.29,0.89,30,科室,30,44,43,42.34,21,2.02,0.98,2.82,1.12,31,科室,31,54,54,60.33,31,1.95,1.12,2.59,1.09,32,科室,32,25,25,18.26,10,1.83,0.73,1.88,0.72,6+,综合,51,病房,4,33,科室,33,68,67,47.52,27,1.76,0.71,3.00,0.72,24+3,（,13A,病房）,34,科室,34,88,87,82.06,56,1.47,0.94,2.17,0.95,50+,癫痫中心,6,35,科室,35,44,43,37.54,28,1.34,0.87,2.17,0.91,2016,年,10,月总计,6028,5934,6020.2,1816,3.32,1.01,3.69,0.99,与绩效挂钩方案,绩效,=,（科室单床效率,-,平均单床效率）床位数,x,变,量,P=,（,E-e,）,bk,8,月,:K=50,9,月：,K=75,10,月：K=75,11,月：,K=75,2015,年与,2016,年部分效率数据比较,出院量,平均住院日,2015,年,2016,年,差值,2015,年,2016,年,9.1,9.5,8.8,8.9,9.1,9.1,8.4,8.3,8.3,8.3,8.2,8,8.1,7.8,8.7,8,8.4,8.3,8.1,8.2,8.2,8.1,1,月,2,月,3,月,4,月,5,月,6,月,7,月,8,月,9,月,10,月,11,月,合计,5704,4431,5960,6189,5812,5966,6663,6174,6277,5572,6333,65081,6125,5114,7212,6727,6619,6414,6531,6779,6807,6032,7081,71441,421,683,1252,538,807,448,-132,605,530,460,748,6360,2016,年,10,月节假日单床工作量,2016,年,10,月各科室节假日（国庆,+,周末）出入院病人单床工作量统计排名,节假日期间收入院病人,节假日期间办出院病人,排名,出院科室,床位数,节假日出入 节假日出入院,院病人工作 病人单床工作,量合计 量合计,出院人 入组人,数 数,工作量,单床工,作量,CMI(,平,均疾病,难易度）,出院人 入组人,数 数,工作量,单床工,作量,CMI(,平,均疾病,难易度）,1,2,3,4,5,6,7,8,9,科室,1,科室,2,科室,3,科室,4,科室,5,科室,6,科室,7,科室,8,科室,9,30,62,48,50,66,21,53,42,57,74.91,141.65,108.31,98.03,118.1,30.78,70.99,55.7,66.22,2.50,2.28,2.26,1.96,1.79,1.47,1.34,1.33,1.16,27,17,78,75,84,6,19,3,20,27,17,78,75,84,6,19,3,20,37.94,34.08,41.05,44.64,46,16.88,28.82,7.48,41.79,1.26,0.55,0.86,089,0.70,0.80,0.54,0.18,0.73,1.41,2.00,0.53,0.60,0.55,2.81,1.52,2.49,2.09,27,57,105,108,115,7,40,20,12,27,54,105,108,114,7,40,20,12,36.97,107.57,67.26,53.39,72.1,13.9,42.17,48.22,24.43,1.23,1.74,1.40,1.07,1.09,0.66,0.80,1.15,0.43,1.37,1.99,0.64,0.49,0.63,1.99,1.05,2.41,2.04,11,科室,11,70,74.28,1.06,2828,40.24,0.57,1.44,35,34,34.04,0.49,1.00,12,科室,12,37,36.58,0.99,19,19,16,0.43,0.84,28,28,20.58,0.56,0.74,13,科室,13,27,23.79,0.88,13,12,9.15,0.34,0.76,19,19,14.64,0.54,0.77,14,科室,14,90,75.14,0.83,52,51,32.83,0.36,0.64,76,74,42.31,0.47,0.57,15,科室,15,36,28.24,0.78,17,17,12.15,0.34,0.71,19,19,16.09,0.450.85,16,科室,16,132,99.25,0.75,35,35,51.04,0.39,1.46,32,32,48.21,0.37,1.51,17,科室,17,323,199.36,0.62,84,83,50.33,0.16,0.61,104,98,149.03,0.46,1.52,18,科室,18,31,17.07,0.55,8,8,6.97,0.22,0.87,10,10,10.1,0.33,1.01,19,科室,19,30,16.32,0.54,5,5,8.85,0.30,1.77,3,3,7.47,0.25,2.49,20,科室,20,6,3.13,0.52,0,0,0,0.000.00,2,2,3.13,0.52,1.57,21,科室,21,73,32.54,0.45,5,5,4.39,0.06,0.88,26,25,28.15,0.39,1.13,22,科室,22,25,9.5,0.38,1,1,0.39,0.02,0.39,9,9,9.11,0.36,1.01,23,科室,23,59,21.3,0.36,9,9,10.12,0.17,1.12,10,10,11.18,0.19,1.12,24,科室,24,21,7.52,0.36,5,5,4.72,0.22,0.94,4,4,2.8,0.13,0.70,25,科室,25,10,3.51,0.35,2,2,2.64,0.26,1.32,1,1,0.87,0.09,0.87,26,科室,26,51,15.26,0.30,6,6,4.94,0.10,0.82,13,12,10.32,0.20,0.86,27,科室,27,16,4,0.25,6,6,2.06,0.13,0.34,4,4,1.94,0.12,0.49,28,科室,28,10,2.39,0.24,2,2,1.82,0.18,0.91,1,1,0.57,0.06,0.57,29,科室,29,27,5.46,0.20,9,9,2.98,0.11,0.33,8,8,2.48,0.09,0.31,30,科室,30,60,9.68,0.16,11,11,6.59,0.11,0.60,6,6,3.09,0.05,0.52,31,科室,31,56,3.85,0.07,2,2,2.84,0.05,1.42,1,1,1.01,0.02,32,科室,32,105,6.59,0.06,8,8,4.34,0.04,0.54,6,5,2.25,0.02,33,科室,33,28,0,0.00,0,0,0,0.00,0.00,0,0,0,0.00,34,科室,34,4,0,0.00,0,0,0,0.00,0.00,0,0,0,0.00,35,科室,35,4,0,0.00,0,0,0,0.00,0.00,0,0,0,0.00,2016,年,10,月总计,1810,1515.74,0.84,682,679,607.08,0.34,0.89,932,916,908.66,0.50,第,30,页,55,分,医疗（工作量）,15,分,15,分,答辩情况,教学情况,15,分,科研情况,2,、,DRG,用于医疗职称评定,部分服务的,DRGs,和权重,男性绝育：,0.215,10,岁以下败血病：,1.512,主要头颈部手术：,5.595,婴儿住院，小于,750,克：,20.190,关节内窥镜检查：,0.538,主要胸部手术：,6.233,颅外血管手术：,2.966,骨髓移植：,6.256,肝移植：,26.697,内 科,DRG,工作量,40,分,门诊量,15,分,医疗（工作量）,外 科,DRG,工作量,45,分,门诊量,10,分,内科病房工作量,u,住院两个科以上病人,的分割门诊工作量,工作量,=,平均疾病难易程度,病人数量,外科病房工作量,u,自己管的病人、非自己管的病,人,u,主刀,u,一助,u,二助,将门诊手术和操作加入工作量中,会诊量,=3,倍门诊量,外出医疗任务,=2,倍住院工作量,支援新疆,=3,倍住院工作量,支援西藏,=5,倍住院工作量,参与埃博拉外援,=10,倍住院工作量,管理病房,VIP,病人,=5,倍工作量,.,加分规则,明年职称评定医疗分数计算方案,计算医师单日工作量,=,（,DRG,方式评估医师病房,+,门急诊工,作量）,/,（,365-,门诊量,同职称平均日门诊量,-,不能用,DRG,方,式评估工作量折合天数）,拟提副高医师内外科排一队,拟提正高医师内外科排一队,单日工作量最高的医师为,55,分，其他人员给予相应分数,3,、单人工作量,临床科室单人工作量,=,（,DRG,方式评价的病房工作量,+DRG,方式评价的门急诊工作量）,/,总人数,-,科研人数,-,教学人数,-,（科室不能用,DRG,方式计算的日均工作量,/,医院单人日均,工作量）,-,（科室日均门诊量,/,医院单人日均门诊量）,用于评价科室人力资源配备状况,目录,第一部分,公立医院改革形势,第二部分,DRG,的管理工具在医院的应用,第三部分,DRG,的资金支持功能,临床路径,37,详,DRG,的资金支持功能,临床路径,在这部分，我们将详细介绍临床路径相关管理,临床路径定义,临床路径（,clinical pathway,，,CP,）是针对一组特定诊断或处置，综合临,床、护理、药剂、检验、麻醉、营养、康复、心理以及医院管理等多,学科医学知识，依据住院的时间流程，结合治疗过程中的效果，对检,查治疗的项目、顺序和时限进行规定，建立一套标准化治疗模式，达,到有效利用医疗资源，规范医疗行为，提升医疗质量、控制医疗成本、,优化医疗服务流程的目的,壹,制定总方针,贰,按照实施步骤进行,1,2,3,4,纸板路径的制作,电子化路径的生成,依据问题进行质控,电子路径作为质控工具运用,时间,出院病人数加新生儿出院数,入路径总人数,入径率,%,2010,年四季度,12929,5285,40.9,2011,年,54604,37689,69,2012,年,61042,47757,78.2,2013,年,66063,53618,81.2,2014,年,67990,61366,90.26,2015,年,73912,67289,91.04,合计,336540,273004,81.12,我院,5,年来进入路径人数和入径率,修正,路径应用,路径,流程,现状出发,总结,1.,纸板路径的特点,适于病程短,病情变化小,较少并发症,诊断清楚,2.1,准备阶段,临床各科选出个案管理员：年轻、懂电脑、和主任关系好,个案管理员培训,科主任培训,讨论路径制作方法,确定路径种类,2.,电子路径的生成,2.2,种类,以主要诊断制作路径,以手术和操作方法制作路径,以临床治疗方法制作路径,2.3,实施阶段,有路径走路径,没有路径走待建路径,个案管理员，医务处、信息中心人员，工程师共同讨论，提出问题，,解决问题,显示病人列表及基本信息,医生选择病人,医生进入临床路径开医嘱,录入初步诊断的拼音码,系统自动提示路径名称,系统自动调用路径字典,点击启用,包：黄色圆点表示必选包,例如：,护理、饮食、术式等,特点：,性质相同，互相排斥；多选一,组：多条功能相近的医嘱的组合,特点：,用途相似，不会排斥；可选多,引入两个概念：包、组,必选项不做要填变异,可选项做了要填变异,遗漏可补选,因故调整执行时间,发送时：系统强制检查必选项,是否都选了,共有,5,项必选项,未选择，需依次说明原,因,目前是第,1,项,对于路径里没有的医嘱，可以选择“新增按,钮”，新增医嘱。,增加：头颈部,CT,血管造影,变异轨迹的管理模块,时间上的变异,推后：整天、包、组、单条,提前：包、组、单条,随时可以查询变异情况,第,3,天手术医嘱推后到第,5,天,3,、依据问题进行质控,3.1,质量控制,准确,与质量,密切相关,易得,有效,指标体系的建立,指标遴选原则,个体纠错,3.3,质控周报,个体培训,奖惩原则,个体考试主任您好！,2014,年,5,月全院从路径中选出的医嘱数,/,全部执行医嘱数为,36%,。上周（,6,月,2,日,-6,月,8,日）内分泌科路径中医嘱比例低于全院均值的有：,罗樱樱 黄,勍,22.64%/,申家琦,4142164,、罗樱樱 徐明艳,22.98%/,闫维丽,5008233,、吴静 官春兰,25.13%/,金平,4214253,、吴静 陈津川,29.16%/,李金凤,5004146,、吴静 胡普平,30.52%/,于桂华,4066444,、吴静 何金山,31.69%/,李文,成,4214476,。如有疑问，请联系赵医生,13600000000,。谢谢！,3.6,通过临床路径开医嘱比较短信,主任您好！,2014,年,5,月全院从路径中选出的医嘱数,/,全部执行医嘱数为,36%,。上周（,6,月,2,日,-6,月,8,日）内分泌科路径中医嘱比例低于全院均值的有：,罗樱樱 黄,勍,22.64%/,申家琦,4142164,、罗樱樱 徐明艳,22.98%/,闫维丽,5008233,、吴静 官春兰,25.13%/,金平,4214253,、吴静 陈津川,29.16%/,李金凤,5004146,、吴静 胡普平,30.52%/,于桂华,4066444,、吴静 何金山,31.69%/,李文,成,4214476,。如有疑问，请联系赵医生,13600000000,。谢谢！,3.6,通过临床路径开医嘱比较短信,11,月,28-12,月,3,日（上周）科室,1,出院,3,人，其中进入正式路径,2,人，完成路,径,1,人。进入正式路径但没有完成路径的有,1,人：罗卫民,4151901,刘岩,/,李广,学。应该进正式路径，但是走待建路径的,0,人。请督促医生改进，如有疑问,请电话联系,3.7,临床路径完成情况个体纠错短信模板,科室,2,主任：您们好！,2012,年,7,月,30,日至,8,月,5,日，下列出院病例为完成路径,病历，但路径只运行一天，影响临床路径质量，其中：,4167350/,穆新林,林则行,/17,天,/1,天。,目前已列入质控周报管理,3.8,提前完成路径个体纠错模板,2,月,4,日,-2,月,10,日科室,2,出院,36,人，其中,3,人没有进入路径管理，包括：董霄,松高莉,/,张光远,4180800,肺部阴影性质待查,/,肺部阴影待查,-,待建路径；穆新,林张放,/,王俊杰,4180329,肺部阴影待查,-,待建路径；卢冰冰周德训,/,余茂,4137494,肺炎,/,肝移植术后,-,待建路径。如果有路径而未进路径，请督促临,床医师进入路径管理，如没有相应路径，科室考虑制作相应路径。,3.9,待建路径管理,4.1,方法,利用路径再生成功能,现有使用路径再生成,4,、电子路径作为质控工具运用,自,2012,年,3,月,6,日至,2013,年,3,月,21,日共使用,377,例,同一待建路径名称累计人次居第二位,科室希望制订正式路径,74,例：,“,计划分娩,_,待建路径,”,概述,4.1,自动生成设置条件,查询,2012,年,4,月,7,日至,2013,年,4,月,7,日入院患者,随机选择,100,个患者数据生成路径,随机选择一个患者的医嘱为基准,出现频次,10,次的医嘱设为必选项,出现频次,6,次的医嘱设为可选项,出现频次,6,次的医嘱删除,75,4.2,自动生成路径情况,住院天数,5,天,所有医嘱共,88,条,必选医嘱,10,条，可选医嘱,78,条,76,4.3,科室修改情况,新增医嘱,6,条（其中增加两种抗生素、一条饮食医嘱和一条耗材医嘱）均为可,选项,4,条医嘱可选项变为必选项：左侧卧位、,产科复诊、陪住费、留陪住一人,删除,2,条医嘱（入院、第四天中的陪住费）,77,78,79,80,81,82,83,谢谢,！,赵越,