医院需求报告及业务流程.doc

医院需求报告及业务流程 医院需求报告医院需求报告 及业务流程及业务流程 2 内容内容/CONTENTS 1 医院的组织管理医院的组织管理/ ORGANIZATION IN HOSPITAL3 1.1 医院的部门构成/ DEPARTMENT STRUCTURE IN HOSPITAL.3 1.1.1 按工作性质和任务划分医院部门（中国）/ Departments of Chinese hospitals are divided by their nature and mission.3 1.1.2 现代医院组织部门划分（理论上）/The classification of modern hospitals (theoretically).5 1.2 我国综合医院一般组织结构图.6 1.3 中国医院人员职类和职称/ DUTIES AND TITLES OF TECHNICAL POSTS IN CHINESE HOSPITAL7 1.4 临床科室和医技科室构成及药剂科组织结构.8 2 医院业务流程医院业务流程/ WORKFLOW IN HOSPITAL.11 2.1 就诊病人工作流程/ WORKFLOW OF PATIENT.13 2.1.1 门诊业务/ Outpatient 13 2.1.2 急诊业务/Acute .16 2.1.3 住院业务/ Inpatient.18 2.2 药品业务工作流程/ PHARMACY WORKFLOW.30 2.3 财务业务工作流程.37 2.3.1 财务37 2.3.2 会计41 3 1 医院的组织管理医院的组织管理/ Organization in hospital 1.11.1 医院的部门构成医院的部门构成/ / DepartmentDepartment structurestructure inin hospitalhospital 1.1.1 按工作性质和任务划分医院部门（中国）按工作性质和任务划分医院部门（中国）/ Departments of Chinese hospitals are divided by their nature and mission. 4 门诊部门诊部 Outpatient Admin 医院部门（中国）医院部门（中国） Dept. in Chinese hospital 诊疗部门诊疗部门（病房和门 诊各临床科室业务 部门） 也称临床科室 Diagnosis 提供资金提供资金 acceptance-type financing 承兑型的资金融承兑型的资金融 通通 account receivable financing 应收筹资帐款应收筹资帐款 backdoor financing 后门融通资金后门融通资金 black market financing 黑市筹资黑市筹资 capital financing 提供资本提供资本 commercial financing 提供商业资提供商业资 金金 conditional financing 附条件融资附条件融资 domestic shipment financing 国内运输国内运输 中货中货 物融资物融资 export financing 出口资金融通出口资金融通 external financing 外部筹资外部筹资 inventory financing 存货资金融通存货资金融通 joint financing 联合联合共同共同投资投资 loan financing 贷款筹措贷款筹措 long-term financing 长期资金融通长期资金融通 permanent financing 永久性筹资永久性筹资 project financing 项目资金筹措项目资金筹措 real estate financing 购置不动产借款购置不动产借款 stock financing 发行股票以融通发行股票以融通 资金资金 supplementary financing 补充资金补充资金 financing n.筹措资金筹措资金, 理理 财财, 筹集资金筹集资金, 融资融资, 财务财务, 资资 金金 药品药品 Drug 药库药库 Drug stock 药房药房 Pharmacy 12 物资物资 Material 卫生材料卫生材料 Sanitation material 易耗品易耗品 Daily use stuff 设备与固定资产设备与固定资产 Insrument check new-come patients and dangerous patients situation, treatment plan to all patient; make decisions on big operation, special exam or therapy; spot-check prescriptions, medical cases, care quality; listen to suggestions of doctors, nurses; carry out teaching work. 主治医师/ Duty doctor 对所管辖的病人分组进行系统查房，对新入院，重危，诊断未 明，治疗效果不好的病人进行重点检查与讨论。听取医师和护士的 反映，检查病历并纠正其中错误的记录，检查医嘱执行情况及治疗 效果，决定出院，转院问题。/ Inspection all patients in groups (new- come, in danger, unclearness, ineffectiveness), discuss and seek for better solution for those patient, listen to doctors and nurses suggestion, check and revise errors in medical case; confirm the prescriptions execution and therapy; make decision of discharge or transferring to other hospitals. 住院医师/ Inpatient doctor 重点巡视危重，疑难，待诊断，新入院，手术后的病人，同时 巡视一般病人。检验化验单，分析检验结果，提出进一步检查或治 疗意见，检查当天医嘱的执行情况，给予必要的临时医嘱并开写次 晨的特殊检查的医嘱，检查病人的饮食情况，主动征求病人对医疗， 护理，生活等方面的意见。/ Focus inspection on patients of in danger, difficulty, new-come, post-operation while take a look of other patients; check exam result reports, analyze reports, propose therapy for the next step; check daily execution of prescription; make temporary prescription if necessary and special check request of next morning; check patient intake, and ask for feedback from inpatient about treatment, care in hospital. b)午后查房/ Afternoon inspection 住院医师对自己所分管的病人进行一次重点巡视，检查当天医嘱执 行情况和病情变化，重点是观察危重病人，新入院的病人，手术后 的病人或次日将实施手术的病人，在此基础上做好向夜班医师的交 班准备。/ This is the most importance inspection for inpatient doctor. Check execution of prescription and variation of disease; focus on patients in danger, new-come, post-operation or pre-operation; prepare for shift handover. c)夜间查房/ Night inspection 由夜班值班医师进行的一次重点巡视和对危重病人进行的连续查诊。 / Inspection focused on patients in danger and keep them watched. d)危重病人查房/ Ward of patients in danger 23 这是指对病房内的危重病人发现问题要及时组织主治医师或科主任 查房并做出有效处理。/ This wards for patients in danger where duty doctor or department director will keep them watch in case any prompt measure is necessary. e)教学查房/ Educational inspection f)院长查房/ Dean inspection 3， 会诊/ Consultancy a)科内会诊/ Consultancy within department 由经管主治医师或高年住院医师提出，由科主任或主任医师召集。/ Proposed and organized by head doctor or senior inpatient doctor. 也可由主治医师邀请本科有关的医务人员参加会诊讨论。/ Head doctor may invite related personnel from other departments. 会诊时由经管住院医师报告病历及诊治情况，要求会诊目的和主要议题， 通过讨论，以期明确诊断治疗意见。/ In the consultancy, inpatient doctor in charge will report on the medical situation and treatment, participants can share their opinion to reach a better solution. b)科间会诊/ Cross-departmental consultancy 如果病情已超出本科的范围，需要其他专科协助诊疗者。/ In some cases, support from other departments may be necessary. 由经管医师提出，上级医师（指主治医师以上）同意，填写会诊单，提出 会诊的要求和目的，送交会诊科室。/ Proposed by inpatient doctor in charge and confirmed by his/ her superior. The invitation with the requirement and purpose then can be sent to invited departments. 应邀科室应派主治医师以上的人员会诊，一般要在接到会诊单的两天内完 成，会诊后要填写会诊记录。/ Invited departments should send doctor above duty doctor level to attend the consultancy. And the consultancy should be concluded with a report. 会诊时主管住院医师或主治医师应在场陪同，介绍病情，直接听取会诊意 见。/ In the consultancy, inpatient doctor in charge or duty doctor should make a report of disease situation and collect suggestions of participants. c)全院会诊/ Consultancy of hospital 特别疑难病人，或病情需要多科共同协作诊疗者，可进行全院会诊。/ For some special case, all departments may be invited to consultancy. 全院会诊由科主任提出，报医务科同意后召开。/ Directors of department have right to propose such consultancy and medical administrative office will confirm the proposal. 应提前将会诊病例的病情摘要，会诊目的，和拟邀请的人员报院医务科， 由医务科决定会诊日期，并通知有关科室。/ The sponsor should prepare the 24 history of the disease, consultancy objective, and invited participants. The medical administrative office will decide the time and inform related departments. 全院会诊由申请科主任主持，也可由医务科主持，主任医师报告病历，全 院会诊时业务副院长和医务科长应该参加，统一会诊意见，由业务副院长 或医务科长作总结方案，统一明确诊疗方案。/ Sponsor will preside the consultancy, make report about disease history. Vice dean in charge of medical affairs and director of medical administration department should attend this kind of consultancy. A clear treatment plan should be finally reached by this consultancy. 经管住院医师做好会诊记录，会诊后将会诊摘要记入病历病程录。/ The consultancy minute should be including into the patient medical case. d)院外会诊/ Consultancy with other hospitals 本院难以解决的疑难病人需要其他医院专科帮助诊疗者可进行院外会诊。 / In some cases, even all doctors of one hospital cant handle some diseases. This hospital may ask help from other hospitals. 院外会诊由科主任提出或由主治医师提出经科主任批准，报请医院医务科 同意后与有关医院进行联系。/ Consultancy with other hospitals should be proposed by directors or head doctor and then the medical administrative office can contact other hospitals for help. 院外会诊应填写会诊单，由医务科盖章后送往有关医院。/ Consultancy request sheet should be filled, sealed by cachet of medical administrative office and then sent to other hospitals. e)急诊会诊/ Emergent consultancy 上述科内，科间，全院，院外会诊都有两种：一般和急诊的区别，凡病情 危急者在会诊单上注明“急”字，必要时要电话联系或派人急送会诊单直 接邀请。应邀科室应立即派医师前往。/ For all consultancies, if the consultancy invitation is marked with “emergent”, receivers must try all chance to send proper doctors to go or make a phone call to clarify. f)院内外大会诊/ Consultancy within hospital and between hospitals 重大医疗纠纷或特殊病种，特殊病历者，可进行院内外大会诊。For some very special cases, this kind of consultancy will be launched to solve problem. 由科主任提出，报请院医务科同意，须业务副院长批准。/ This kind of consultancy should be proposed by directors, checked by medical administrative office and then confirmed by vice dean in charge. 提前将有关病历摘要等资料送交被邀科室和医院。/ All related materials should be sent to invited departments and hospitals. 大会由业务副院长主持，提出大会诊的科主任报告病情，专人记记录。/ This consultancy should be presided by vice dean in charge, reported by 25 director and the whole process should be recorded in form of minute of meeting. 4， 病例讨论/ Medical case discussion a)疑难病例讨论/ Discussion about difficult cases b)术前病例讨论/ Discussion before operation c)出院病例讨论/ Discussion before discharge d)死亡病例讨论/ Discussion over death e)临床病例讨论/ Clinical discussion 5， 治疗/ Treatment 医院住院诊疗必须按医师的医嘱方式进行/ All treatment must follow doctors prescription a)治疗种类/ Treatment classification 药物治疗/ Medicine treatment 手术治疗/ Operation 物理疗法/ Physical treatment 放射治疗/ Radiation treatment b)医嘱种类/ Prescription classification 长期医嘱：根据病人的病情所采用的治疗方法需要连续进行的称为长期 医嘱，这种医嘱如果医师不予更改或撤消则长期执行下去，因此对长期 医嘱的日期概念并无确定的规定，可以数日，也可以 1-2 周或更长的时 间。/ Long-term prescription: the prescription covers treatment should be carried to patient for a long time. This kind prescription can only be ceased against doctor order. Otherwise it will carry on. There is no exact definition of the time period, it can be several day, 1-2 weeks or even longer. 临时医嘱：根据病人的病情变化所采用的临时治疗方法，它具有医嘱的 时间性强，要及时执行，临时医嘱只有一次性指令的作用，不能连续执 行。/ Temporary prescription: some temporary treatment method used for only once. This kind of prescription should be carried out immediately after doctor makes it and only valid for once. 备用医嘱：多用于夜间临时需要或出现某种特殊情况时的应用，备用医 嘱有特殊标志。/ Backup prescription: this is some measure may be taken in some special cases. Backup prescription will always be marking out separately. c)医嘱单/ Prescription sheet. 医嘱单分为长期医嘱和临时医嘱/ Prescription sheet can be divided as long- term one or temporary one. 长期医嘱（24 小时以上医嘱）/ Long-term prescription (valid for more than 24 hours) 26 包括定期执行的次数（如每日执行的次数）和长期备用医嘱。/ The sheet will give information like the frequency of the treatment and backup prescription if need. 内容/ Content： 日期，时间，护理常规，护理级别，饮食，药物，各种治疗/ Date, time, regular care requirements, care level, food confirm the bed number, patients name, drugs name, dosage, time, and usage. 手术后和分娩后要停止术前和产前医嘱，重开医嘱，并分别转抄于医嘱 记录单和各项执行单上。/ After operation, birth-giving, all previous prescription should be ceased. New prescription made and carried. 凡需下一班执行的临时医嘱，要交代清楚，并在护士的值班记录上注明。 / Any prescription needed to carry out in next shift; nurses should make a clear statement on the shift handover log. 医师无医嘱时，护士一般不得给病人做处理，但遇抢救危重病人的紧急 情况下，医师不在，护理师可针对病情临时给予必要的处理，但要做好 记录并及时向经管医师报告。/ Nurse cant give any treatment to patients without doctors prescription unless in emergency. But afterwards, nurse should make a clear report of what has been done to patients. 对长期医嘱要认真检查，尤其对毒性药，抗生素和激素等，要注意其疗 效和药物副作用。/ Patients performance (especially some by-effect performance) after long-term prescription should be closely observed especially when poison, antibiotic or hormone is taken. 护士主要执行注射，输液，输血，吸氧，导尿，灌肠，包扎，标本采取 等一般治疗技术。/ Its nurse responsibility to carry out prescriptions like: injection, transfusion, blood transfusion, oxygen breath-in, urine-guide, clysis, tie-up, specimen taking. 6， 病历书写/Writing of medical case a)病历书写的重要意义/ Significance b)病历书写的基本要求/ Basic requirement c)门诊病历的规范要求/ Writing requirement of outpatient 28 d)住院病历的规范要求/ Writing requirement of inpatient 7， 晨会与值班制度/ Morning meeting and duty regulation. 8，随访/ Casual inspection 医院需求报告及业务流程 住住院院病病人人 门门诊诊转转住住院院 急急诊诊转转住住院院 E En nt te er r f fr ro om m o ou ut tp pa at ti ie en nt t , , a ac cu ut te e, , o or r d di ir re ec ct t i in np pa at ti ie en nt t 入入院院计计划划 A Ad dm mi is ss si io on n p pl la an n 入入院院登登记记 A Ad dm mi is ss si io on n p pr ro oc ce es ss s 住住院院预预约约病病人人 E En nt te er r f fr ro om m r re es se er rv va at ti io on n 医医师师站站 D Do oc ct to or r w wo or rk ks st ta at ti io on n 护护士士站站 N Nu ur rs se e w wo or rk ks st ta at ti io on n 住住院院药药房房 I In np pa at ti ie en nt t p ph ha ar rm ma ac cy y 手手术术室室 O Op pe er ra at ti io on n 治治疗疗科科室室 T Tr re ea at tm me en nt t 检检查查科科室室 E Ex xa am m 医医嘱嘱 P Pr re es sc cr ri ip pt ti io on n 检检查查单单 E Ex xa am m r re eq qu ue es st t 治治疗疗单单 T Tr re ea at tm me en nt t r re eq qu ue es st t 手手术术单单 O Op pe er ra at ti io on n r re eq qu ue es st t 处处方方 D Dr ru ug g r re eq qu ue es st t 医嘱执行单 （治疗） Checklist of prescription 口服单 Oral sheet 注射单 Injection sheet 静脉点滴单 transfusion sheet 护护理理 C Ca ar ri in ng g 摆药中心 Preparation center 领药单及药品 Drug application form 摆药单 Drug prescription form 处方药 须检查医师处方 Picking-up 药品 Drugs 交交预预交交金金 P Pr re ep pa ay ym me en nt t 补交预交金通知单 Repayment reminder 出院通知单 Discharge notice 出出院院结结算算 D Di is sc ch ha ar rg ge e s se et tt tl le em me en nt t 病病案案室室 M Me ed di ic ca al l c ca as se e r ro oo om m 财财务务科科 F Fi in na an nc ce e d de ep pa ar rt tm me en n t t 病病人人出出院院 D Di is sc ch ha ar rg ge e 财务数据 Accounting data 医疗数据 Medical data 30 2.22.2 药品业务工作流程药品业务工作流程/ / PharmacyPharmacy workflowworkflow 概述概述/ In general： 药剂科是负责医院药剂工作的部门，它集药品采购，供应，调剂，制剂，经济管 理，临床药学，科研工作及贯彻执行药政法规为一体。/ Pharmacy department is responsible for all drug related work in hospital. Pharmacy dept. purchase, supply, transfer, produce, manage, research drugs and carry out drug related regulations of China government. 药剂科的性质药剂科的性质/ Features of Pharmacy： 1， 专业技术性/ Professional 2， 业务监督性/ Superivion 3， 信息指导性/ Guiding 4， 管理效益性/ Effeciancy 5， 工作服务性/ service-oriented 任务任务/ Responsibilities： 1， 根据本院医疗，科研和教学的需要，按照本院制定的基本用药目录采购 药品，做好药品的保管，供应及帐卡登记。/ Make “basic drug catalog” based on the hospitals medical, research and educational needs; store the drugs, and manage drugs by registration cards. 2， 根据本院医师处方或摆药单，请领单，及时准确地调配处方，摆发药品。/ Prepare drugs against preparation sheet, picking-up check. 3， 配合临床，研制中西药新制剂。/ Co-work with clinical department to research and produce new drugs. 4， 药品质量控制。/ Control quality of drugs. 5， 配合临床做好新药的试验及药品的评价工作。/ Co-work with clinical department to do the trial and evaluation of new drugs. 6， 检测药品的不良反应，及时向有关部门提出意见/ Report to authorities if there is any bad effects of new drugs found. 7， 药品的信息收集，开展其研究/ Collection information to carry out drug research. 药剂工作管理药剂工作管理/ Management to drugs 1， 质量管理/ Quality management 2， 经济管理/ Economy management 药剂科负责全院药品，化学制剂，卫生材料的供应。/ Pharmacy dept. is responsible to supply drugs, chemical product and materials of the hospital. 医院按批发价购入药品，通过处方调配发给病人的药品按零售价计。/ Hospital purchase drugs with wholesale price and sell them to patient with retail price. 加成金额=零售价-批发价/ added-value= retail price-wholesale price 加成率=（零售价-批发价）/批发价 * 100% / added-value ratio=(retail price- wholesale price)/ wholesale * 100% 西药加成率为 15%。/ Added-value of west medicine is 15% 中成药加成率 16%。/ Added-value of Chinese medicine is 16% 31 中草药加成率 30%。/ Added-value of Chinese herb is 30% 制剂室根据制剂操作规程配置本院需要的自制制剂，除收原材料费，包装材 料费外，还可收加工费。/ Pharmaceutics of hospital can produce drugs based on certain procedure and charge its products for material, package and surcharge. . 医院每月药费的流动金额为全院的流动金额的 40%-60%。/ The float cash in pharmacy dept is 40-60% of total float cash in hospital. 药库的结存计划量需考虑销售情况。/ Usually the purchase plan should take the sales situation into consideration. 月药品购销的加成率，西药不低于 14.5%，中药不低于 18%。/ Month added- value in west medicine is no less than 14.5%, in Chinese no less than 18%. 西药库库存金额不超过三个月的出库金额，药品盘点帐物误差率不超过 1%， 药品的耗损率，西药1%，中药2%。/ The storage value of west medicine is no more than that of three-month stock-out; Inventory different is allowed within 1%; damage ratio: west medicine1%, Chinese medicine2%. 3， 药品管理/ Drug management a)药品三级管理/ Three-level management system 一级管理：/ Level one 范围：麻醉药品和毒性药品/ Coverage: anesthetic, poison 方法：有关国家规定/ Regulated by government 二级管理：/ Level two 范围：精神药品，贵重药品，自费药品/ Coverage: psychosis drug, precious drug, drug beyond coverage of medical insurance. 方法：专柜存放，专帐登记，贵重药品每日清点，精神药品管理国 家的有关规定。/ These medicine should be kept and logged separately and count daily; psychosis drugs are also regulated by government. 三级管理：/ Level three 范围：普通药品/ Coverage: common drug 方法：金额管理，季度盘点，误差率1%/ These drugs should be count quarterly and the difference ratio must be less than 1% 医院可以采用以及、二级、三级管理方式，也可以单独采用其中的 b)麻醉药品管理/ Anesthetic management 医师：必须有开麻醉药品处方权的医师开出。/ Only authorized doctor has right to prescribe such drugs. 病人：建立病历，每次开药在病历上有记录/ Every prescription must be recorded in patient medical case 药剂人员： 专人负责，专柜加锁，专用帐册，专用处方，专册登记/ Only authorized chemist can keep these drugs in special cabinet, using special book to do separate record. c)精神药品管理/ Psychosis drugs 同上/ See above 32 d)医用毒性药品管理/ Poison 同上/ See above e)有效期药品管理/ Validity management 药品生产的批号与效期的关系：/ The relationship between batch number and validity 批号是表示药品生产日期的一种编号，也是表示这批药品是同一次 投料，同一生产工艺所生产的产品，药品批号一般均采用六位数字表示， 前两位表示年份，中间两位数字表示月份，末两位数字表示日，如 1992 年 11 月 29 日生产的药品，批号为 921129. 分号，表示同一天投料次数 号，如 1991 年 11 月 29 日第一批投料生产的药品，批号为 911129-1/ Batch number is usually a six-digit code showing the produce date of a set of same drugs used by pharmaceutics. The first two digits stand for year, then month, then day. If there are more than one set produced in a same day, different set will be divided by one more digit behind that six. e.g. drugs set 2 produced on Nov. 29th 1992 have batch number: 921129-2. 4， 计划管理/ Plan management 5， 设备管理/ Instrument management 药剂科管理制度药剂科管理制度/ Pharmacy department management system 1， 药品采购供应管理/ Drug purchase-supply management a)计划采购管理/ Purchase plan management 根据药品的使用情况及库存结存量，提出药品采购计划。/ Purchase plan management is to generate drug purchase plan based on the consumption of drug and inventory. 了解用药动态，新药使用情况和药品质量等情况，做好供应工作。/ Purchase plan management is to get the idea of trends of drug consumption, new drug development and drugs quality and to guarantee supply work. 对药品质量不合格，原包装破损的药品及时退货，调换并登记。/ Purchase plan management is to return or exchange damaged or poor quality drugs and make record of these kinds of situation. 根据季节疾病发病率情况，调整药品品种及购入量。/ Purchase plan management is to adjust drugs catalog and purchase amount based on different season. b)库房管理/ Stock management 对毒，麻，精神药品及危险药品应按规定分别设库存放。/ Stock management requires that poison, anesthetic and psychosis drugs be stored separately. 库房药品的摆放可按药理，剂型，给药途径，字母顺序等分类存放，同 时要建立货位卡，便于盘点和发药。/ Normal drugs storage should be in accordance with their usage, package or other standard. A location card system should be set up for easy inventory and delivery. 入库药品要认真验收，应注意品种，规格，数量，有效期，真伪等。/ Stock-in check should be focused on speculation, brand, number, validity etc. 药品一般应遵循先进先出的原则。/ FIFO standard is usually applied. 33 库管人员调动工作时，必须在第三者监督下办理交接手续，并要三方签 字。/ In case any changes happen with stock-keepers, a third party is needed to monitor the handover. c)供应管理/ Supply management 供应管理指对药库供给调剂室（药房） ，制剂室等有关科室药品过程的管 理。/ Supply management is to manage drug flow from drug stock to all pharmacies or department. 领用科室向库房领药时，应填写请领单一式三联，一联交药品会计出帐， 一联药库存查，一联领用科室留存，领药后库房保管员和领药人员应签 字。/ When department ap