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Public hospitals stand in need of strengthening cost control and improving operational efficiency to balance public welfare and economic benefits.Taking practice and exploration of ultrasound department as an exam-ple,it integrates the advantages of TDABC with cost management.Take the merits of time driver and activity driver,realizes direct cost accounting under the clinical pathway,strengthen capacity management capabilities un-der the integration of industry and finance,with a view to providing a powerful cost control tool for public hospitals to sensibly respond to pricing reform and reasonably make operational decisions.
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Objective:To search for evidence of capacity management in patients undergoing extracorporeal membrane oxygenation support therapy, and summarize the evidence to provide evidence-based basis for medical staff to evaluate and manage the capacity of such patients.Methods:This study was an evidence-based nursing study. Based on the 6S evidence model, relevant evidence on patient volume management in extracorporeal membrane oxygenation support therapy was systematically searched for relevant evidence on patient volume management in extracorporeal membrane oxygenation support therapy from top to bottom, including UpToDate, the National Guidelines Library of the United States, the Scottish Interhospital Guidelines Network, the Medical Guidelines Network, the Extracorporeal Life Support Organization website, Cochrane Library, PubMed, CINAHL, Wanfang, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Database. Based on the inclusion criteria, clinical guidelines, expert consensus, clinical decision-making, evidence summary, and systematic evaluation were selected for literature quality evaluation to extract the best evidence. The search period was from April 10, 2017 to April 10, 2022.Results:A total of 11 articles were included and 20 pieces of evidence were extracted, which were categorized into four categories: extracorporeal membrane oxygenation team composition and personnel qualifications, evaluation and monitoring, capacity management objectives, and capacity management measures.Conclusions:Based on a large amount of evidence of extracorporeal membrane oxygenation support for patient capacity management, this study can provide a reference basis for clinical workers to develop extracorporeal membrane oxygenation support treatment capacity management plans.
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This paper summarized nursing points for caring 23 cases undergoing pediatric heart transplantation,including:characteristics of accessing and protection of hearts,collaboration in pediatric heart transplantation,nursing of capacity management,temperature controlling,extracorporeal membrane oxygenation and delayed sternal closure during surgeries.The average length of hospitalization for 23 cases was 24.5±8.3 days,1 case died from primary graft failure after 19 months,the rest of 22 cases survived,and cardiac function recovered to NYHA class Ⅰ-Ⅱ.
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Objective To investigate the clinical significance of PiCCO monitoring in critically ill patients' capacity management. Methods Selected 40 cases critically ill patients from January 2012 to January 2014 in our ICU,22 cases were treated with PiCCO monitoring,established the observation group,18 cases were treated with superior vena cava catheterization monitoring,established the control group,the APACHEⅡ score, HR, MAP, CVP,EVLWI GEDVI,me-chanical ventilation time,ICU stay time were compared. Results GEDVI in the observation group at third day after treatment significantly increased than the first day,and the second day(P<0.01﹚. The EVLWI in the observation group at third day after treatment obviously decreased than before treatment, the first day,the second day after treatment re-spectively(P<0.05﹚. The APACHEⅡ score, HR, MAP, CVP in observation group respectively compared with the control group, there was significant difference (P<0.05﹚. The mechanical ventilation time, ICU stay time in the ob-servation group were significantly shorter than that the control group(P<0.05﹚. Conclusion The capacity index applica-tion of PiCCO monitoring in critically ill patients to guide capacity management is superior to CVP monitoring,facili-tates the assessment the treatment and prognosis in critically ill patients.