静脉采血质量改进行动的成本效果分析

doi:10.3761/j.issn.0254-1769.2025.23.003

摘要/Abstract

摘要：

目的通过质量改进行动提升住院患者静脉采血质量，评价质量改进行动的成本与效果，为高频护理操作流程的质量改进提供参考。方法 2023年1月18日—2024年10月13日，在北京市某三级甲等综合医院74个住院护理单元中，采用计划-实施-分析与研究-处理循环开展静脉采血质量改进行动。应用成本效果分析法，将静脉采血相关差错发生率、每千出院患者因重复采血延长的诊疗时长作为效果指标，将因重复采血增加的年化医疗成本、质量改进行动实施成本作为成本指标，评价静脉采血质量改进行动的成本与效果。结果通过质量改进，全院住院患者静脉采血相关差错发生率从0.18%降低至0.03%（P<0.001）；每千出院患者因重复采血延长的诊疗时长由1 853.89 min缩短至377.04 min；因重复采血增加的年化医疗成本由26 433.89元降低至4 160.30元；质量改进行动实施成本总计18.36万元。结论通过质量改进行动能够降低静脉采血相关差错发生率，缩短因重复采血延长的诊疗时长，减少因重复采血增加的医疗成本，总体可提高护理质量、提升诊疗效率、减少医疗资源浪费。

关键词: 静脉采血, 质量改进, 成本效果分析, 卫生经济学, 护理管理研究

Abstract:

Objective To improve the quality of blood specimen collection among inpatients through a quality improvement（QI） action and evaluate its cost-effectiveness，provide multi-dimensional references for the QI action of high-frequency nursing processes and procedures. Methods From January 2023 to October 2024，a QI action for venous blood sampling based on the Plan-Do-Study-Act（PDSA） cycle was implemented across 74 wards in a tertiary general hospital in Beijing. By cost-effectiveness analysis（CEA），effectiveness indicators included the incidence of venous blood sampling-related errors and the diagnostic and treatment time prolonged by repeat venous blood sampling. The medical costs were calculated from repeat blood sampling due to venous blood sampling-related errors and implementation cost of each phase. The cost and effect of the action to improve the quality of venous blood collection were evaluated. Results Following the intervention，the incidence of venous blood sampling-related errors among inpatients decreased from 0.18% to 0.03%（P<0.001）. The diagnostic and treatment duration prolonged by repeat venous blood sampling was reduced from 1 853.89 minutes to 377.04 minutes per 1 000 discharged patients. The annualized medical cost due to repeat blood sampling dropped from 26 433.89 yuan to 4 160.30 yuan. The total implementation cost of the QI action was 18.36 thousand yuan. Conclusion The QI action significantly reduced venous blood sampling-related errors，shortened diagnostic and treatment delays caused by repeat blood sampling and lowered associated medical costs. Overall，it improved nursing quality，enhanced diagnostic efficiency，and reduced medical resource waste.

Key words: Venous Blood Sampling, Quality Improvement, Cost-Effectiveness Analysis, Health Economics, Nursing Administration Research

黄婵, 张海燕, 徐银环, 池艳宇, 王琳楠, 刘岩, 闵玉娣. 静脉采血质量改进行动的成本效果分析[J]. 中华护理杂志, 2025, 60(23): 2835-2842.

HUANG Chan, ZHANG Haiyan, XU Yinhuan, CHI Yanyu, WANG Linnan, LIU Yan, MIN Yudi. Cost-effectiveness analysis of quality improvement action for venous blood sampling[J]. Chinese Journal of Nursing, 2025, 60(23): 2835-2842.

图/表 6

表1 静脉采血质量改进行动的4轮PDSA循环

Table 1 Implementation details of the 4-round PDSA cycles for venous blood sampling quality improvement

表2 维持阶段静脉采血操作流程查检发现的质量问题（n=842）

Table 2 Inspection results of quality issues in venous blood sampling procedures during the sustainability phase（n=842）

表3 单次重复静脉采血成本估算

Table 3 Cost estimation for a single repeated venous blood sampling procedure

表4 质量改进行动不同阶段各类人员的工时

Table 4 Personnel working hours at each phase of the quality improvement action

图1 静脉采血质量改进行动各阶段静脉采血相关差错发生率变化趋势

Figure 1 Trends in the incidence of venous blood sampling-related errors across different phases of quality improvement action

表5 静脉采血质量改进行动各阶段每千出院患者因重复采血延长的诊疗时长

Table 5 Prolonged diagnostic and treatment duration per 1 000 discharged patients due to repeated venous blood sampling at each phase of the quality improvement action

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