Research on the value of double closed-loop management mode in maintenance and fault control of hemodialysis machine / 中国医学装备

Objective:To construct a double-closed-loop management model for medical equipment and explore its application value in hemodialysis machine maintenance and fault management.Methods:Based on the closed-loop management of clinical operation of medical equipment and the closed-loop management of technical support,a dual closed-loop management model of equipment was constructed.65 hemodialysis machines in clinical use in Huashan Hospital Fudan University from January 2021 to January 2023 were selected and divided into a conventional mode and double-closed-loop mode according to different management modes.The conventional mode adopted conventional equipment management methods,and the double-closed-loop mode adopted a double-closed-loop management model.The cost-effectiveness,social benefit,failure occurrence,effective management quality matters,disinfection status,average patient waiting time and satisfaction were compared between the two groups.Results:The hemodialysis machine operating profit growth rate,diagnosis and treatment cost growth rate,service life index,scientific research service growth rate,diagnosis and treatment service growth rate,startup rate and operation rate of the double-closed-loop mode were(3.95±1.04)%,(3.80±0.58)%,(1.58±0.31)%,(4.30±0.95)%,(7.91±1.58)%,(96.58±2.76)%and(89.90±5.58)%,which were higher than those of the Conventional mode,the difference was statistically significant(t=5.418,10.070,7.490,17.570,11.820,8.849,6.840,P<0.05).The technical support expenses growth rate,bacterial colony count,bacterial endotoxin content and average patient waiting time of patients in the Double-closed-loop mode were(2.60±0.33)%,(0.370±0.008)cfu/ml,(0.0063±0.0011)EU/ml and(0.76±0.13)h,which were less than those of the conventional mode,the difference was statistically significant(t=23.040,82.985,14.482,19.530,P<0.05).The incidence rate of hemodialysis machine failure in the double-closed-loop mode was 9.23%(6/65),which was lower than that in the conventional mode,the difference was statistically significant(x2=6.392,P<0.05);among the 120 items of management data collected,quality control testing,maintenance and repair,clinical operation,information data,and scrap processing effectiveness rates were 95.83%(115/120),89.17%(107/120),96.67%(116/120),95.00%(114/120),and 97.50%(117/120),respectively,which were higher than those of the conventional mode,the difference was statistically significant(x2=15.238,16.596,9.808,15.585,16.119,P<0.05).Conclusion:The application of closed-loop management model to hemodialysis machine maintenance and fault management can effectively improve equipment cost-effectiveness,social benefits,management quality and patient satisfaction,and reduce the incidence of faults.

Construction of a closed-loop management model of drugs in operating room based on intelligent Internet of Things system / 中国药房

OBJECTIVE To provide reference for improving the level of hospital pharmaceutical management for operating room drugs. METHODS The operating room pharmacy of our hospital utilized the concept and means of the Internet of Things （IoT） to build an intelligent IoT system for operating room drugs （hereinafter referred to as the “IoT system”）， and optimized and improved it. The quality of drug management in the operating room of our hospital during the initial phase of the IoT system （Q1 2022） and after optimization and improvement （Q1 2023） were compared by setting indicators from four aspects： quality， efficiency， cost， and satisfaction. RESULTS After more than a year of optimization and improvement， our hospital has built a traceable IoT system for the entire drug process that integrated surgical anesthesia systems and hospital information systems， with the direction of drug circulation in the operating room as the axis， using intelligent drug vehicles as the hardware foundation， and anesthesia doctor’s order information system as the software medium. After the optimization and improvement of the IoT system， the standardized score of anesthesia orders in the operating room increased from （68.5±3.5） points in the initial period to （97.0± 2.7） points； the consistency rate between accounts and materials increased from （82.40±8.85）% to （96.50±4.80）%； the time of taking medicine was shortened from （40±8） min to （12±3） min； the frequency of drug withdrawal was reduced from （36.0± 6.5） times/day to （15.5±3.0） times/day； the cost of loss drugs was decreased from （1 292.61±305.90） yuan to （594.24±195.05） yuan； the satisfaction was increased from （80.5±6.5） points to （96.0±3.0） points. All indicators were significantly improved with statistically significant differences （P＜0.05）. CONCLUSIONS The intelligent IoT system constructed by our hospital effectively ensures the accessibility， timeliness， and safety of intraoperative medication， which is conducive to improving the quality of drug management in the operating room.

Current situation and quality control of multidisciplinary clinic——a case study of a tertiary hospital in Guangxi / 现代医院

The Multi-disciplinary diagnosis and treatment(MDT)outpatient service is widely used in the diagnosis and treatment of patients with tumors,difficult critical and complex diseases and multiple diseases.The purpose of this paper is to study the one-stop treatment mode of MDT outpatient service in tertiary hospitals and the closed-loop management after diagnosis,which plays an important role in integrating medical resources,optimizing medical treatment process,improving patient medical experience,and ensuring medical quality and safety.In view of the weak links and difficulties in quality control in MDT outpa-tient management,such as insufficient attention from functional departments,low enthusiasm of clinicians,low initiative of pa-tients,imperfect information construction of MDT outpatient service,poor quality improvement effect,etc.,Effective manage-ment methods such as core members'guidance,supporting incentive and assessment mechanism,regular reporting of quality,im-proving information construction,extending service scope,and increasing publicity efforts have been adopted for continuous im-provement,and remarkable results have been achieved in increasing the number of cases and diseases,expanding brand influ-ence,and improving the quality of consultation.

Exploration of centralized closed-loop management mode for gynecological day surgery / 中华医院管理杂志

Day surgery can effectively improve the utilization of medical resources. In October 2015, an obstetrics and gynecology hospital established a gynecological day surgery center to centrally manage gynecological day surgery and continuously optimize the management process. In July 2019, the hospital established an intelligent information platform for gynecological daytime surgery managemen. Based on this platform, the " evaluation-appointment-hospitalization-follow-up-chronic disease management" information management process was implemented, the " pre hospital-in hospital-post hospital" full process medical quality and safety monitoring was carried out to form a centralized closed-loop management mode for gynecological day surgery led by gynecologists. Under this management mode, the number of gynecological day surgeries in the hospital has increased from 2 866 cases in 2019 to 4 065 cases in 2021, providing convenient medical services and personalized chronic disease management services, and ensuring the quality and safety of gynecological day medical care, for reference for promoting the high-quality development of day surgeries in specialized hospitals.

Design and implementation of blood transfusion management system based on electronic medical record application and grading / 现代医院

Objective To address the issues of decentralized blood transfusion services and the persistence of paper-based approval processes,as well as to meet the requirements of electronic medical record grading and interoperability assess-ments.Methods Combining the requirements of the assessments,we have restructured and designed the blood transfusion serv-ice processes,and developed a comprehensive closed-loop management system for clinical blood transfusion based on an integrat-ed platform.Results Six major closed-loop processes were established for blood transfusion services and blood management.This transformation led to more standardized transfusion documentation,centralized blood transfusion services,and enabled data sharing across the entire hospital.Conclusion The rationality,standardization,and safety of clinical blood transfusions have improved,leading to a reduction in the incidence of adverse transfusion reactions.

Practical research on fishbone diagram combined with PDCA closed-loop management in orthopedic operating room teaching / 中华医学教育探索杂志

Objective:To explore the effect of fishbone diagram combined with PDCA(plan, do, check, action) closed-loop management in the teaching of orthopedic interns in operating room.Methods:The 60 interns received by the Department of Orthopedics in our hospital from January 2019 to August 2020 were randomly divided into the conventional group and the observation group in average. The conventional group used traditional methods, and the observation group introduced fishbone diagram combined with PDCA closed-loop management. The theoretical and practical assessment scores and the evaluation of satisfaction with the teaching were compared between the two groups before and after the teaching in the operating room. SPSS 22.0 was used for t-test and Chi-square test. Results:The scores of each theoretical assessment, the total scores of theoretical assessments, and the scores of practical assessments, in the observation group were higher than those of the conventional group ( P<0.05). The satisfaction rates of interest, effectiveness, rationality, and popularization with teaching in the observation group were 100.00%, 100.00%, 96.67%, and 100.00% respectively, which were higher than those (80.00%, 83.33%, 80.00%, and 83.33% respectively) in the conventional group. Conclusion:The application of fishbone diagram combined with PDCA closed-loop management in orthopedic operating room teaching can improve the performance of interns in the assessment, and can also achieve better teaching satisfaction.

Closed-loop management strategies for patients with severe mental disorder complicated with COVID-19 infection / 四川精神卫生

With the fluctuating condition of the COVID-19 epidemic， the current findings remain unclear about the preventive measures and coping strategies for patients with severe mental disorders at the nodes of the transmission chain. Past experience in prevention and control has shown that establishing an effective system for emerging infectious disease prevention and control and establishing transitional wards in specialist mental healthcare institutions play a significant role in reducing the risk of epidemic transmission. However， there is no formulated strategy for the management of patients with severe mental disorders and COVID-19 infection who have recurrent or worsened mental symptoms during the diagnosis and treatment of COVID-19 and are unable to cooperate with the treatment in Fangcang shelter hospitals or infectious wards. Based on the field research in the front line of the epidemic prevention， this paper discusses the management strategies of patients with severe mental disorders and COVID-19 infection in the context of the practical difficulties in managing patients with severe mental disorders and COVID-19 infection， emergency management strategies， protective conditions for front-line psychiatric medical staff and the legal basis for the management of patients with severe mental disorders and COVID-19 infection in emergency situations.

Practice of a hemodialysis alliance in the context of closed-loop hospital management / 中华医院管理杂志

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Design and implementation of single disease data quality management system based on hospital information system / 中华医院管理杂志

Quality management and control of single disease is a means to continuously improve medical quality and safety by building a set of quality control indicators and evaluation systems based on the whole process of disease diagnosis and treatment. In the actual single disease management process, the reporting of each disease involved data from various systems such as electronic medical records, and the data integration was difficult. While the traditional manual reporting method took a lot of time and the data accuracy could not be guaranteed. In the development process of hospital informatization, a hospital has designed a set of intelligent full-closed loop single disease management platform based on the hospital information system, by integrating the existing human and information data resources of the hospital. This platform integrated functions of single disease intranet reporting, in-depth capture of reporting elements, single-disease quality index management, and single-disease real-time intelligent control, in order to promote more refined and intelligent disease management and thus steadily improve medical quality and safety.

Application of closed-loop blood transfusion information system in the whole process management of blood transfusion / 中国输血杂志

【Objective】 To explore the effect of mobile transfusion closed-loop information system in the whole process management of clinical blood transfusion. 【Methods】 The hospital information system (HIS) of Soochow Hospital affiliated to Nanjing Medical University was integrated with the blood information system (BIS) and personal digital assistant (PDA) to build a closed-loop transfusion management process to ensure the safety of clinical blood use. From May 2021 to April 2022, 1 395 patients who were admitted to our hospital for blood transfusion therapy were studied. Among them, 632 patients from May to October 2021 (before the implementation of closed-loop management) were the control group, and 763 patients from November 2021 to April 2022 (after the implementation of closed-loop management) were the observation group. Before and after the implementation of closed-loop management, we compared the implementation rate of double-checking before blood sample collection, rate of transfusion within 30 min after blood issuing, implementation rate of double-checking of bedside transfusion, situation of patrol every 15 minutes, rate of transfusion completed within 4 h, rate of nursing documentation standardization, so as to evaluate the improvement effect of the whole process of transfusion management. 【Results】 The implementation rate of double-checking before blood sample collection was 99.48%(759/763) in the observation group and 93.99%(594/632) in the control group; the transfusion rate within 30 min after blood issuing was 95.02%(725/763) in the observation group and 91.46%(578/632) in the control group; the implementation rate of double-checking of bedside transfusion was 100%(763/763) in the observation group and 95.73%(605/632) in the control group; the complete rate of patrol every 15-min was 94.36%(720/763) in the observation group and 90.35%(571/632) in the control group; the completion rate of transfusion within 4 h was 95.81%(731/763) in the observation group and 92.25%(583/632) in the control group; the rate of nursing paperwork standardization was 98.03%(748/763) in the observation group and 81.80%(517/632) in the control group, and the difference between the two groups was statistically significant (P<0.05). 【Conclusion】 The mobile transfusion closed-loop information system can realize the whole process management of clinical blood transfusion, effectively improve the standardization of blood transfusion and transfusion documents, and guarantee the safety of clinical blood transfusion.

Application of intelligent closed-loop mobile nursing management system in quality management of blood transfusion / 中国输血杂志

【Objective】 To explore the effect of intelligent closed-loop mobile nursing management system in quality management of blood transfusion. 【Methods】 The mobile nursing system and the cold chain management system of our hospital were integrated to realize intelligent closed-loop management of blood transfusion. After consulting medical records, 789 blood recipients, admitted to the Department of Hematology of our hospital from January to December 2017 (before the implementation of closed-loop management), were selected as the control group, and 836 blood recipients, admitted during January to December 2018 (after the implementation of closed-loop management), were selected as the observation group. A self-designed blood transfusion standard management checklist was adopted, with the number of standard execution items as the numerator and the total number of checked items as the denominator to obtain the standard implementation rate. The checking rate of blood sample collection, blood transfusion rate within 30 min after blood issuing, the execution rate of double check specification and inspection specification, the completion rate of RBCs transfusion within 4 h and qualified rate of blood transfusion nursing record before and after the implementation of closed-loop management were compared by chi-square test or Fisher's exact probability method to evaluate the efficacy of blood quality management improvement. A total of 8 head nurses from clinical departments (Hematology Department, Cardiac Surgery Department, Operating Room, Comprehensive ICU) involved in blood transfusion were selected for semi-structured interviews. The interviews focused on the effect of intelligent closed-loop mobile nursing information system in quality management of clinical blood use, and the results of the interviews were analyzed. 【Results】 The double check execution rate of blood transfusion, the checking rate of blood sample collection specification, the transfusion rate within 30 min after blood issuing, the execution rate of blood transfusion inspection, the completion rate of RBCs transfusion within 4 h, the qualified rate of blood transfusion nursing record in the observation group and the control group after and before the implication of the intelligent closed-loop mobile nursing management system were 100%(836/836) vs 97.72%(771/789), 99.04%(828/836) vs 97.34%(768/789), 97.97%(819/836) vs 95.06%(750/789), 99.28%(830/836) vs 94.93%(712/789), 99.16%(829/836) vs 97.47%(769/789) and 100%(836/836) vs 89.73%(708/789), respectively, showing significant improvement (P < 0.05). The time spend on the record, summary and feedback of quality control results was significantly shortened. 【Conclusion】 The application of intelligent closed-loop mobile nursing management system in the quality management of clinical blood use can effectively improve the efficiency of blood transfusion, nursing quality and the safety of clinical blood use.

Exploration and Practice of Closed-loop Management of Drug Valid Date in the Intelligent Outpatient Pharmacy / 中国药房

OBJECTIVE：To explore the closed-loop management mode of drug valid date in the intelligent outpatient pharmacy，and to provide reference to improve the management level of drug valid date and ensure the safety of drug use in patients. METHODS ：The model and practice of closed-loop management of drug valid date in the intelligent outpatient pharmacy were summzired from the aspects of dispensing system ， logistics system ， temperature and humidity monitoring system ， management of drugs to be about to expired ，internal quality control and performance evaluation. The patients ’satisfaction degree of the indicators were compared between the new and old hospital districts. RESULTS ：The intelligent drug dispensing system ， logistics and information flow system ，temperature and humidity monitoring system were established in the new district of our hospital，and management system of drugs to be about to expire ，internal quality control and performance evaluation system were established. The workflow of drug validity management was optimized ，the pharmacy working environment was improved ，and the pharmaceutical service quality and pharmacy management level were improved. The results of satisfaction survey of outpatients in new and old distrcts showed that the indicators of patients ’satisfaction（service attitude ，work quality ，drug consultation ，waiting time）in new distrct were improved to different extents ，compared with old district. The satisfaction of special storage tips and waiting time in new district were all significantly higher than old district ，with statistical significance （P＜0.05）. CONCLUSIONS ： The design and management concept of intelligent outpatient pharmacy in our hospital has been significantly improved ，the drug valid date management is more scientific and reasonable than before ，and the patient satisfaction is improved.

Whole process closed-loop traceability management for high-value consumables using international standard bar code / 中华医院管理杂志

Scientific management of high-value medical consumables is key to hospital development and service. By setting up a lean logistics management(SPD)platform in the hospital and decoding the international standard bar code(GS1/HIBC), the hospital has established a general coding library of high-value consumables. With RFID Internet of things technology and equipment introduced and business operation templates of each link combined, we have achieved a closed-loop management of both sides of the high-value consumables process.

Discussion on primary closed-loop management mode of chronic diseases in Ningxia / 中华医院管理杂志

The pre-during-post hospital closed-loop management of chronic diseases is an efficient way to upgrade the current chronic disease management level. The authors described the feasibility, what to build and imperative problems in implementing such a closed-loop management in primary level in Ningxia. The introduction focused on the construction of a chronic disease management path for multiple diseases, the implementation of a closed-loop management model for chronic diseases based on the " three in one model(specialist-family physician-health manager)" , the promotion of primary physician training and standardization management level, as well as the establishment of a community-centered three-level prevention and treatment system for chronic diseases. These efforts aim at promotion of chronic disease management outcomes, elevation of patients′ health and quality of life, and minimization of people′s economic burden.

Reform and effects on administrative ward rounds at hospitals / 中华医院管理杂志

The study is to establish the administrative ward round system and its effect evaluation system under the modern hospital management conditions, and explore the formation of a standardized, scientific and replicable standard mode of Administrative Ward round. According to the annual ward rounds plan, clinical departments and administrative departments were organized to decide the major issues of a department according to the procedures of " hearing-evaluation-discussion-decision " , and to ensure the implementation of management. Since 2016, administrative ward round has been carried out in 9 departments, and the medical quality and operational efficiency have been improved significantly. The closed-loop administrative ward rounds mode can effectively promote the modernization of hospital management system through the joint decision-making of clinical departments and functional departments.

Design and practice of medical consumables management based on JCI standards / 医疗卫生装备

Objective To introduce JCI standards into medical consumables management in order to improve the overall management of consumables.Methods Root cause analysis (RCA) method in JCI management standards was used to execute root cause analysis of each key point in medical consumables management.PDCA Cycle was involved in to promote medical consumables management.Results JCI management standardized the path,solved some problems and promoted the level during medical consumables management.Conclusion JCI standards contribute to the standardization and humanization of medical consumables management,and also enhances the patient safety at the same time.

Design and practice of medical consumables management based on JCI standards / 医疗卫生装备

Objective To introduce JCI standards into medical consumables management in order to improve the overall management of consumables.Methods Root cause analysis (RCA) method in JCI management standards was used to execute root cause analysis of each key point in medical consumables management.PDCA Cycle was involved in to promote medical consumables management.Results JCI management standardized the path,solved some problems and promoted the level during medical consumables management.Conclusion JCI standards contribute to the standardization and humanization of medical consumables management,and also enhances the patient safety at the same time.

Research on the Application of Material Closed Loop Management in Medical Institutions Based on the Perspective of Management Accounting / 中国卫生经济

Objective:Through the closed loop management mode,it realized the whole process of material information could be traced back,especially in the medical business level.Methods:Based on the requirement of management accounting,the integrated accounting and business information were in accordance with management accounting.Results and Conclusion:It set up different management nodes in the closed loop of the materials,such as medicine,sanitary materials and test reagents,so as to get the relevant information.The problems of the extensive management of materials could be solved to improve the efficiency of the management of hospital materials.

Design and Application of the Closed-loop Management System for Laboratory Specimens / 医学信息学杂志

Based on the problems existing in the original specimen management process of the First Affiliated Hospital of Guangdong College of Pharmacy,the paper proposes achieving the closed-loop management process of laboratory specimens through wireless network technology,PDA,laboratory specimen bar code,QR codes of patients and interaction of multiple systems,and describes the functional design and application effect of the system.The application of the closed-loop management process for laboratory specimens can better standardize and normalize the management of specimens.

Design of closed-loop management system of medical equipment based on virtualized cloud computing / 中国医学装备

Objective:To research and design a closed-loop management system of medical equipment based on virtualized cloud computing so as to enhance the level of maintenance management for medical equipment and reduce cost of maintenance.Methods: Under the operation environment of Cente OS6.4, the closed-loop management system of medical equipment was designed and developed through used design tool of Rational Rose 2007, programming software of JAVA and My SQL data management system.Results: After the management system were used one year, medical workers could real-timely grasp the situation of medical equipment and the communication time about application of equipment has been reduced. The management department of medical equipment could guide clinical department to reasonably allocate and use the medical equipment through implemented closed-loop and dynamic management.Conclusion: The closed-loop management system of medical equipment based on virtualized cloud computing has series of advantages including friendly interface, simple operation, shortened communication time, reduced cost of maintenance, and it can achieve closed-loop management of whole life cycle for medical equipment.