Donn S M, Gates M R, Kiska D J
Department of Pediatrics--Newborn Services, University of Michigan Medical Center, Ann Arbor.
J Perinatol. 1993 May-Jun;13(3):190-6.
In October 1983 a computerized data base system was implemented to perform quality assurance in the neonatal referral region of the University of Michigan. This system was customized to match and expand forms and reports already in use. It is menu driven, requires only rudimentary skills, and is compatible with existing computer equipment. To assess the effectiveness of the program in monitoring and improving neonatal care within the region, data from the first full year (1984) were compared with data from the last full year (1990). Statistically significant changes were found for referring physician presence at transfer, a greater assumption of initial stabilization procedures by community hospital personnel (continuous cardiorespiratory monitoring, orogastric tube placement, provision of respiratory support, blood glucose screening, blood gas evaluation, blood culturing, and antibiotic therapy), and an overall improvement in patient status before transfer. Review of reports generated by data analysis enables design of educational programs that are hospital specific and that focus on problems or deficiencies determined during quality assurance conferences. The chief benefit of this system is the provision of an objective basis for constructive criticism, which leads to both cognitive and behavioral changes in care providers and ultimately improves the delivery of care to neonates.
1983年10月，一个计算机化数据库系统开始运行，用于对密歇根大学新生儿转诊区域进行质量保证。该系统经过定制，以匹配并扩展已在使用的表格和报告。它由菜单驱动，只需要基本技能，并且与现有的计算机设备兼容。为了评估该项目在监测和改善该区域新生儿护理方面的有效性，将第一个完整年度（1984年）的数据与最后一个完整年度（1990年）的数据进行了比较。发现转诊时转诊医生在场情况有统计学意义的变化，社区医院人员在初始稳定程序方面承担了更多工作（持续心肺监测、放置鼻胃管、提供呼吸支持、血糖筛查、血气评估、血培养和抗生素治疗），以及转诊前患者状况总体有所改善。对数据分析生成的报告进行审查有助于设计针对特定医院的教育项目，这些项目聚焦于质量保证会议期间确定的问题或缺陷。该系统的主要好处是为建设性批评提供了客观依据，这会导致护理人员在认知和行为上发生变化，并最终改善对新生儿的护理服务。
