With the rapid development of China's economy and society, people's living standards have been continuously improved, health awareness has been further strengthened, and more and more attention has been paid to medical health. Therefore, people not only pay attention to traditional disease diagnosis and treatment, prevention methods and health care knowledge, but also tend to all-round health care, including the need for professional interpretation of some auxiliary treatment or inspection reports in the diagnosis and treatment process, such as the interpretation of radiological images, clinical medication guidance, nursing treatment measures and other clinical specialized health care knowledge, thus giving birth to the relevant medical technology departments of major hospitals in China Willingness of nursing departments to set up special clinics. Zhejiang Provincial People's Hospital (hereinafter referred to as "our hospital") has also set up medical technology, pharmacy and nursing specialist clinics according to the needs of the public. The relevant practices and ideas are summarized as follows.
1 policy background
On May 14, 2021, the general office of the State Council issued the opinions of the general office of the State Council on promoting the high-quality development of public hospitals, Clearly stated in the document "We will focus on people's health, strengthen the dominant position of public hospitals, adhere to the leadership of the government, public welfare and public hospitals, adhere to the integration of medicine and prevention, the integration of emergency and peace, and the equal emphasis on traditional Chinese and Western medicine, with the goal of establishing and improving a modern hospital management system, strengthen system innovation, technology innovation, model innovation and management innovation, accelerate the expansion of high-quality medical resources and regional balanced layout, and strive to develop public hospitals through five years of efforts The mode has changed from scale expansion to quality and efficiency improvement, the operation mode has changed from extensive management to refined management, the allocation of resources has changed from focusing on material factors to paying more attention to talent and technology factors, providing strong support for better providing high-quality and efficient medical and health services, preventing and resolving major epidemics and sudden public health risks, and building a healthy China ", which focuses on model innovation, Aiming at the model innovation, the document further defines "promoting the innovation of medical service model, opening rational drug use consultation or drug treatment management clinics, and carrying out precision drug use services." The document specifies that the pharmacy department (Pharmacy Department) can set up special clinics. This is totally different from the previous concepts and management requirements. The doctor law of the people's Republic of China stipulates that only qualified doctors can be qualified to open clinics in medical institutions and receive and treat patients. Under the new policy environment, it will not violate the existing laws and regulations, but also keep pace with the times to meet the medical needs of the people. It is believed that the state will further interpret the judicial provisions of the doctor law of the people's Republic of China, or loosen the diagnosis and treatment behavior of major hospitals when opening medical technology, pharmacy and nursing specialist clinics, so as to adapt to the development and changes of the situation.
2 current status of specialized outpatient service in medical technology, pharmacy and nursing departments
At present, major hospitals across the country have tried to set up medical technology, pharmacy and Nursing Clinics in order to meet the growing needs of the people for diagnosis and treatment and improve the patients' sense of experience in medical services. For example, many large hospitals have set up peripherallyinsertedcentralcatheter (PICC), urinary incontinence care, reproductive health consultation, genetic consultation clinic, lymphedema care clinic, diabetes education clinic and wound stoma clinic, which mainly focus on education, guidance and consultation, and focus on chronic diseases, maternal and child health care and PICC; The radiology image reading clinic of the radiology department pays special attention to the image interpretation of difficult diseases; The pharmacy department mainly provides joint outpatient service for doctors and pharmacists, comprehensive outpatient service for pharmacy and specialized outpatient service for pharmacy, such as nephrotic medicine joint outpatient service, drug consultation outpatient service and anticoagulation pharmacy outpatient service, which have achieved good results, solved the problems or questions of patients and their families in nursing, treatment and medical knowledge, and won the welcome of the majority of patients.
3. Practice in our institute
Since 2010, our hospital has carried out the PICC outpatient service, which has been welcomed by many patients with chronic diseases. At present, there are 40 ~ 60 patients in the daily outpatient service. The outpatient and emergency department sets up a special "PICC outpatient" number to make an independent appointment for registration. "Wound stoma clinic" and "lymphedema nursing clinic" have also been established in recent years. They are respectively registered under anorectal surgery and breast surgery. Due to the improvement of instruments, equipment and examination technology in recent years, more and more pulmonary nodules have been found in the population. The radiology department and respiratory department have set up a "joint pulmonary nodule clinic". There is a great demand for patients, and it is difficult to find the number source 1 of the joint pulmonary nodule clinic. At the same time, the radiology department has also set up a special image reading clinic. Although the number of outpatient services is small, which is in great contrast with the "joint outpatient service for pulmonary nodules", due to the careful, detailed and in place interpretation of experts, the core problems involved in diagnosis and the doubts in the hearts of patients have been solved, so that they have a deeper understanding of their own diseases and achieved the expected outpatient effect. The pharmacy department and the nephrology department have set up a "joint clinic for delaying renal failure", and separately set up "cough and asthma pharmacy service clinic", "anticoagulation pharmacy clinic" and "nephrology pharmacy clinic". The number of patients is gradually increasing. It is found from our practice that at present, the national medical administrative department has no relevant regulations on setting up this kind of medical technology, pharmacy and nursing clinics, especially for personnel qualification, scope of work, diagnosis and treatment specifications, which are negotiated with the opening departments by the hospital outpatient management department with reference to the existing medical and outpatient management systems. Everyone feels the stone and crosses the river without forming a unified system. For example, nursing outpatient number management, some are set independently, some are attached to a clinical department; In addition, people have not yet fully established their medical theory for medical technology, pharmacy and Nursing Clinics. They always think that seeing a doctor can only go to the clinical specialty, and there is no such concept for seeing a doctor in the auxiliary department. The most important thing is that social publicity needs to be strengthened. Patients' awareness of outpatient services such as medical technology, pharmacy and nursing is obviously low, and even many medical staff do not know it. When patients go to the charging window and the service desk to consult such outpatient services, the staff do not give correct guidance. After years of operation, PICC clinic is gradually accepted and recognized by the majority of patients.
4 problems in practice and cause analysis
Based on the problems encountered by large domestic hospitals in setting up medical technology, pharmacy and nursing specialty clinics, combined with the practice of our hospital, it can be summarized that they are mainly affected by policy environment, operation mechanism, standardized management, diagnosis and treatment concept and other factors.
4.1 policy environment
At present, there is no specific policy in China to specify the opening of medical technology, pharmacy and nursing specialty clinics. Therefore, there are no requirements and regulations on the professional qualifications of the visiting personnel of medical technology, pharmacy and nursing specialty clinics, and there are no clear regulations on the business scope, work specifications and charging standards of medical technology, pharmacy and Nursing Clinics. First of all, can medical technology, pharmacy and nursing departments open outpatient clinics? Because the main body regulated by the doctor law of the people's Republic of China is doctors. At the same time, the registered practice categories of these doctors are clinical medicine, Stomatology, public health and traditional Chinese medicine, especially the former. Their practice scope is internal medicine, surgery, pediatrics, otorhinolaryngology and other first-class subjects. If the medical technology, pharmacy and nursing visiting personnel do not have the doctor's practice qualification, they cannot be registered, This has raised questions about whether medical technology and nursing staff are qualified to open outpatient clinics. At the same time, if these clinics are allowed to be opened, what are the requirements for the qualifications of the visiting staff? How to identify those who are qualified and those who are unable to make visits is in front of the outpatient managers.
4.2 exploration of operation mechanism
Setting up medical technology, pharmacy and Nursing Clinics requires continuous investment in human, material and financial resources, but how to ensure the long-term operation of these clinics? Is there a subordinate relationship between the Department and its original department, or is it divided into diagnosis group (diagnosis and treatment group) and technical group according to the mode of radiology department? At the same time, how to charge outpatient consultation fees? Since there is no precedent for medical technology, pharmacy and nursing specialty outpatient service in the past, and there is no example to use for reference, it has always been a hot topic to discuss whether to add its outpatient service fee by referring to the general outpatient service fee or the expert outpatient service fee. It mainly involves the legality and rationality of charges.
4.3 exploration of standardized diagnosis and treatment
How to standardize the diagnosis and treatment behavior and ensure the quality of medical service when setting up medical technology, pharmacy and nursing specialty clinics? For these medical technical and nursing personnel, because they have no experience of visiting in the past and have no diagnosis and treatment norms for medical technology, pharmacy and nursing reception, they are all in the exploratory stage, which will inevitably affect the quality of outpatient diagnosis and treatment service, which has also become an urgent issue for Managers to consider.
4.4 shackles of diagnosis and treatment concept
Because the medical technology, pharmacy and nursing specialty clinics have broken the traditional thinking concept, they used to think that these departments belong to auxiliary departments, and they can not independently open the clinics to patients and make independent medical treatment opinions and suggestions. These ideas are deeply rooted in the people's medical thinking, and even in the medical staff. As a result, it is difficult for medical technology, pharmacy and nursing to establish specialized clinics in the short term to be recognized by the people, and the number of outpatient clinics is relatively small.
5 thinking and suggestions
In view of the above problems, from the management perspective of practicing according to law, standardizing diagnosis and treatment and ensuring medical quality and safety, our hospital has summarized some experience in practice and put forward some thoughts and suggestions, aiming at standardizing the medical service behavior of the industry, promoting more standardized outpatient management, and further improving the quality of outpatient medical service and patient satisfaction.
5.1 define the establishment of institutions and gradually incorporate them into standardized management
First of all, according to national laws, regulations and existing policies, it is feasible for medical technology, pharmacy and nursing departments to set up special clinics, which does not violate relevant laws and regulations. However, people are bound by the thinking of the doctor law of the people's Republic of China and believe that only qualified doctors can go out of the clinic. In fact, many medical technology and nursing visiting personnel only provide consultation with professional knowledge or perform treatment operations according to doctors' instructions, Do not independently issue medication, examination and other diagnosis and treatment orders. Secondly, for the medical institutions that set up medical technology, pharmacy and nursing specialty clinics, it is required that the medical institutions at or above the second level should have the advantages and guarantees in terms of personnel quality, technical ability and emergency treatment. Third, to set up medical technology, pharmacy and nursing specialty clinics, the departments must belong to the approved departments within the establishment; Nursing must be a nursing unit with specialized nursing qualification.
5.2 define the qualifications and requirements of the visiting personnel
The outpatient service of the medical technology department (including medical imaging, inspection, pathology, neuroelectrophysiology, ECG function, etc.) must have the qualification of a licensed doctor and have the title of vice senior or above in relevant disciplines; The nursing staff must have the nursing practice registration qualification, have two years or more of specialized work experience, have the provincial or above specialized nurse training qualification certificate or have 5 years or more of specialized work experience with the title of vice senior or above; Pharmaceutical personnel must have received the standardized training of clinical pharmacists and obtained the post training certificate of clinical pharmacists or the qualification certificate of "drug treatment management" or have a competent pharmacist and have been engaged in clinical pharmacy for more than 3 years. These personnel have rich clinical experience and professional knowledge, and they are the professionals who most want help from outpatient patients and their families in terms of medical service needs.
5.3 define the outpatient business scope and diagnosis and treatment specifications
5.3.1 define the outpatient business scope. Determine the business scope according to the characteristics of each medical technology, pharmacy and nursing specialty, such as the outpatient service set up by the medical technology department, which mainly solves the interpretation of difficult cases, answers questions and dispels doubts, and provides professional expert services for patients; Pharmaceutical clinics are mainly joint clinics and comprehensive clinics, and only special clinics can be opened for individual projects; The nursing specialty clinic mainly solves the nursing work that is outstanding in specialty technology, strong in specialty and good in treatment effect in the process of nursing treatment, and can not be solved by ordinary nursing staff. The nursing specialty clinic is closely related to the clinical specialty. It is a continuous service after specialty treatment. It must have a perfect nursing specialty clinic management system and process, including treatment and consultation. The environment of the treatment room should meet the requirements of hospital sensory control. Special nursing clinics can only be opened for individual items.
At present, the main difficulty encountered by the nursing clinic is that there is no independent prescription right. Doctors' prescribing rights mainly lie in the diagnosis and treatment of diseases, while nurses' prescribing rights pay more attention to the non drug prescribing in the nursing field, or the continuous treatment drug prescribing rights within the scope of doctors' orders. It is suggested that the state should appropriately open certain doctor's order and prescription authority to nursing personnel with specialized nursing qualification, that is, limited to flushing drugs, related consumables and operation items.
5.3.2 define diagnosis and treatment specifications to ensure outpatient service quality. In order to ensure the quality of outpatient medical service and safeguard the legitimate rights and interests of both doctors and patients, according to the basic norms for writing medical records and other industrial rules and norms, all medical technology, pharmacy and nursing professionals must record the medical service process, which shall be kept as legal documents. The corresponding requirements shall be made according to whether the visiting doctors of the above departments have the qualification of medical practitioners. If the visiting doctors of the medical technology departments have the qualification of medical practitioners, their outpatient clinics must write outpatient medical records in accordance with the specifications; However, the visiting staff of nursing specialty clinic and pharmacy related clinic do not have the qualification of doctor, and their relevant nursing treatment process, specialty nursing consultation, medication guidance and medication consultation opinions can be truthfully recorded in writing and included in the patient's outpatient medical record.
5.4 specify standard charges
For the outpatient consultation fees of medical technology, pharmacy and nursing specialty, according to whether the visiting personnel have the medical qualification, if they have the medical qualification, they will be charged according to their professional title. If they do not have the medical qualification, they will be charged according to the general outpatient service, that is, the consultation fee or guidance fee, so as to truly implement the policy requirements of "opening a rational drug use consultation or drug treatment management outpatient service".
5.5 strictly abide by the outpatient management system
Regardless of the medical technology department, nursing specialty, pharmacy and other outpatient services, they are uniformly included in the hospital outpatient management. The management of departments and outpatients should strictly implement the relevant systems of health administrative departments at all levels and hospitals, so as to provide high-quality outpatient medical services for patients.