麻醉品质管理之经验~改善患者於手术室内手术被取消(2009年07月18日).ppt

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1、麻醉品質管理之經驗~改善患者於手術室內手術被取消(2009年07月18日)中山醫學大學附設醫院麻醉科主治醫師劉漢傑9/3/202112009年台灣麻醉品質與安全研討會ReportsoftheInstituteofMedicine(IOM)TheU.S.healthcaresystemperformsfarbelowobtainablelevelsofpatientsafetyandoverallcustomervalues.The1999IOMreportestimatedthat44,000to98,000America

2、nsdieeachyearasaresultofmedicalerrors.(EffectiveClinicalPractice,November/December2000.)9/3/202122009年台灣麻醉品質與安全研討會ReportsofHarvardUniversityRANDresearchersfoundthat3%ofU.S.inpatientsexperienceavoidableharmandthatopportunitiesforsignificantimprovementinpatientfunct

3、ionalstatusaremissedin11%ofchronicallyilloutpatients.9/3/202132009年台灣麻醉品質與安全研討會CharacteristicsofPatientsNumber(%)A.GenderMale38(56.7%)Female29(43.3%)B.Age,mean±SD,Year58.9±20.1C.ASAphysicalstatusI*2(3.0%)II+IIE19(28.4%)III+IIIE39(58.2%)IV7(10.4%)Totalnumberofcases

4、=67(100%)*OneyoungpatientshowedtypeIIofaseconddegreeatrioventricularblockontheEKGmonitorintheOT,oneyoungmaleneededfurthersurgicalworkupaftertheanesthesiawasgiven.9/3/202142009年台灣麻醉品質與安全研討會Table2-ClassificationofpersonswhopostponedorcancelledtheSurgerySurgerywaspos

5、tponedorcancelledbyNumber(%)Anesthesiologist42(62.7%)Beforeanesthesia35(52.2%)Afteranesthesia7(10.5%)Surgeon20(29.8%)Beforeanesthesia9(13.4%)Afteranesthesia11(16.4%)Patientorfamilies5(7.5%)Beforeanesthesia4(6.0%)Afteranesthesia*1(1.5%)Totalnumberofcases=67(100%)Bo

6、ardlettersindicatethesumoftherelateditems.*Thepatient’sfamilycancelledthesurgerybecauseofinsuranceproblems.9/3/202152009年台灣麻醉品質與安全研討會Table3-CategoriesofPatients’SurgeriesPostponedorCancelledinsidetheOperatingTheaterReasonsNumber(%)A.Airwayproblem4(6.0%)B.Changeinm

7、edicalcondition47(70.2%)Untreatedhypertension9(13.4%)Abnormalelectrocardiogram11(16.4%)Respiratoryinstability6(9.0%)HematologicalproblemPoorgeneralconditionOthers*5(7.5%)13(19.4%)3(4.5%)C.Progressofsurgicalcondition9(13.4%)Insufficientworkup6(8.9%)Inoperabilityorn

8、ofurthersurgerynecessary3(4.5%)D.Others**7(10.4%)9/3/20216Table3a-CategoriesofPatients’SurgeriesPostponedorCancelledinsidetheOperatingTheaterTotalnumbe