基于医护一体化的乳腺癌化疗门诊全程管理模式的构建与实践

Construction and Practice of the Whole Management Model of Breast Cancer Chemotherapy Outpatient Clinic Based on Doctor-nurse Integration Mode

  • 摘要:
    目的 探讨基于医护一体化的乳腺癌化疗门诊全程管理模式的构建、实践过程及运行效果, 以期为乳腺癌化疗患者的规范化管理提供参考。
    方法 2019年1月, 北京协和医院乳腺外科通过组建医护一体化团队, 构建包含化疗准备期、化疗期、化疗间歇期的全程管理路径, 建立了全流程预约、分时段就诊、可实现患者闭环式管理的医护一体化乳腺癌化疗门诊全程管理模式。比较该模式建立前(2018年)和建立后(2019年)医疗效率指标、化疗安全指标、化疗门诊人力配比情况、患者及医护满意度。
    结果 该模式建立前, 患者就诊等待时间为30~120(75.40±20.97)min, 化疗门诊年化疗总量为8715人次, 每日需调配2名病房护士参与化疗门诊工作; 模式建立后, 患者根据化疗方案按预约时段到院直接化疗, 无需等待, 化疗门诊年化疗总量为10 101人次, 2个化疗单元可分时段相互调配人力, 病房化疗护士由机动状态转为储备状态, 且护理不良事件、导管相关不良事件、化疗不良反应发生率与模式建立前一致, 均保持为0。与模式建立前比较, 模式建立后患者与医护满意度各维度评分及总分均显著升高, 差异具有统计学意义(P均<0.05)。
    结论 基于医护一体化的乳腺癌化疗门诊全程管理模式有助于提升医疗服务效率、保障化疗安全、优化人力资源配置、提高医患双方满意度。

     

    Abstract:
    Objective To explore the establishment, implementation, and outcomes of an integrated physician-nurse team-based comprehensive management model for breast cancer chemotherapy outpatients, aiming to provide a reference for standardized patient care.
    Methods In January 2019, the Breast Surgery Department of Peking Union Medical College Hospital developed an integrated physician-nurse team and established a full-cycle management pathway covering the pre-chemotherapy, chemotherapy, and inter-cycle phases. This model featured appointment-based scheduling, time-segmented visits, and closed-loop patient management. Key performance indicators-including healthcare efficiency, chemotherapy safety, staffing ratios, and satisfaction levels among patients and healthcare providers-were compared between pre-implementation(2018) and post-imple-mentation (2019) periods.
    Results Before implementation, patient waited times ranged from 30 to 120 (75.40±20.97) minutes, with an annual chemotherapy volume of 8 715 cases. Two ward nurses were routinely redeployed daily to support the chemotherapy clinic. Post-implementation, patients received timely chemotherapy per scheduled appointments without delays, annual chemotherapy volume increased to 10 101 cases, and staffing between two chemotherapy units became flexibly adjustable. Ward nurses transitioned from an on-call to a reserve role. Adverse events (chemotherapy-related, catheter-related, and nursing incidents) remained at 0, consistent with pre-implementation levels. Both patient and staff satisfaction scores significantly improved across all domains (all P < 0.05).
    Conclusions The integrated physician-nurse team-based chemotherapy management model enhances service efficiency, ensures treatment safety, optimizes workforce allocation, and improves satisfaction among patients and healthcare providers.

     

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