PCCM规范查房体系建设课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,呼吸与危重症医学科规范化查房体系建设,呼吸与危重症医学科规范化查房体系建设,1,内科大查房（,Medical Grand Rounds),的历史回顾与现状,内科大查房（Medical Grand Rounds)的历史,2,查房,体系,三级查房,主任,/,副主任医师，主治医师，住院医师，,实习医师,淡化专业，病人不一定能真正得到优质的专业化医疗照护,不能体现现代医生培养要求,/,职能,重复工作，资源浪费，甚至产生代查房签字,主治医查房（,attending rounds),主治医,（副,/,主任医师,/,主治医师）,，,受训专科医师（,fellow),，,住院医师，,实习医师,主治医（,attending physician),负责制,（亚）专科会诊（,Consulting),制,三级查房专业化,教学查房（,teaching rounds),大查房（,grand rounds),查房体系三级查房主治医查房（attending rounds,3,R,ounds,is the,daily,visit,by the,attending physician and team,to all that,physicians patients,on,the ward,.,Rounds,are specific to individual attending physicians and their teams,Rounding,with an attending physician is an important part of medical on-the-job training and,education,but,its primary focus is immediate care for the patients on the ward.,From Wikipedia,查房,（,Rounds,）,Rounds is the daily visit by t,4,A,n,important,teaching tool,and,ritual,of,medical education,and,inpatient,care,present the medical problems and treatment of the patient,doctors,residents and medical students,Pt,was,tradit.,present for the round and,answer,questions,Most dept.at major teaching hospitals will have their own specialized,often weekly,Grand Rounds.,Help doctors keep up to date in important evolving areas which may be outside of their core practice.,Attending grand rounds,is an important supplement tomedical schooland on-the-jobresidenttraining,.,大,查房,（,Grand Rounds,）,From Wikipedia,An important teaching tool and,5,大,查房,（,Grand Rounds,）,Franz J.Ingelfinger,New Eng J Med.1978;229:772,大查房（Grand Rounds）Franz J.Inge,6,Grand,rounds,tends to present the bigger,picture,including experience,with patients over many,years,and,the newest research and treatments in an,area,Grand,rounds,tend to be open to the entire medical professional,community,Grand rounds,can,be,distinguished from,rounds,From Wikipedia,大,查房,（,Grand Rounds,）,Grand rounds tends to present,7,The,tradition of Medical Grand Rounds,at Johns Hopkins can be traced back to,William Osler,the first professor of medicine,beginning in 1889,.,Although,for a long time they have been amphitheater rounds,not bedside rounds,the patient and specific clinical problems,have always been,the focus of discussion,.,The,objective,is to demonstrate,the best in the analysis and treatment of difficult clinical problems,in real-life patients who often tell their own story.,The,patient remains our link between current research and modern therapeutics.,8 a.m.every Friday,Hurd,Hall,Johns,Hopkins Medical Grand,Rounds,Thetradition of Medical Grand,8,北京协和医院内科大查房历史,邓家栋教授说，“我不确切知道，在协和医院内科，大巡诊始于何时，但可以肯定，早在,20,年代就已实行”,北京协和医院内科大查房历史邓家栋教授说，“我不确切知道，在协,9,一个集思广益,、解决患者诊治过程中的疑难问题,交流信息，利于医师之间相互学习,培养人才、增强凝聚力和展现协和内科魅力的平台,一份既有传承、又有发扬的协和文化遗产,一部记录医学大师成长的史册,张孝骞教授，,80,岁,高龄，仍认真参加每一次内科大查房,北京协和医院内科大查房历史,一个集思广益、解决患者诊治过程中的疑难问题北京协和医院内科大,10,根据,2001,年的统计,16,例诊断不明，大查房后,10,例（,63%,）获得正确诊断,27,例疗效不佳，查房后,16,例（,59%,）病情改善或治愈,根据,2010,年的统计,22,例疑难病例中，,18,例（,81%,）于大查房后明确诊断或疗效改善,北京协和医院内科大查房历史,根据2001年的统计北京协和医院内科大查房历史,11,翁心植院士指导的查房,翁心植院士指导的查房,12,内科大查房,历史悠久，医学教育的重要组成部分,内科教学训练的重要部分,跟踪疾病诊断、治疗和研究进展,教育各级医生，促进共同提高,Stanyon M,et al.Clin Med(Lond).2015;15:10-1.,Mueller PS,et al.Mayo Clin Proc.,2006,;,81:313-21.,内科大查房历史悠久，医学教育的重要组成部分Stanyon,13,加拿大内科,大,查房现状调查,McLeod PJ,et al.CAN MED ASSOC J.1990;142:1053-56.,Objiective,Response,;no.of respondents,Strongy agree,Agree,Neutral,Disagree,Strongly disagree,Education,44,4,0,0,0,Presentation of research,findings by departmental,scholars,10,10,26,0,2,Showcase,for“stars”of,attending staff,4,13,26,3,2,Social interaction,4,9,24,7,4,Announcement of departmental notices,1,2,18,11,16,Response s to questionnaire on objectives of,medical grand rounds at teaching hospitals,加拿大内科大查房现状调查McLeod PJ,et al.C,14,内科大查房：面临挑战,医学教育的传统，无证据证实其效果及对病人处理的影响,现代医学发展，传统模式的大查房有些不适宜,大查房在现代医学教育的作用似乎在被淡化，也欠规范,强调专科化难以使一些专家关注大内科知识，不能胜任查房,演变成科主任医学会议或“专家”讲课，非病人问题的讨论,查房质量不高，参与性不高，迟到,医疗、教学质量提高无保障,Stanyon M,et al.Clin Med(Lond).2015;15:10-1.,Mueller PS,et al.Mayo Clin Proc.,2006,;,81:313-21.,内科大查房：面临挑战医学教育的传统，无证据证实其效果及对病人,15,呼吸与危重症医学科规范化查房体系建设,呼吸与危重症医学科规范化查房体系建设,16,加强查房体系建设，规范大查房制度,明确,查房目的与意义,制定,查房规程，并不断完善,确保查房质量,提高,查房的参与,性,提高疑难病诊治能力,加强查房体系建设，规范大查房制度 明确查房目的与意义,17,北京朝阳医院呼吸与危重症医学科大查房规程,北京朝阳医院呼吸与危重症医学科大查房规程,18,北京医院呼吸与危重症医学科大查房规程,北京医院呼吸与危重症医学科大查房规程,19,中日医院呼吸与危重症医学科大查房规程,中日医院呼吸与危重症医学科大查房规程,20,集,大家,智慧，,讨论分析诊断或治疗困难住院患者的病情，优化处理方案,保证,医疗,质量,与,安全,，提高医疗水平，全力、高水平地为患者,服务,呼吸与危重症医学科大查房,医疗目的,集大家智慧，讨论分析诊断或治疗困难住院患者的病情，优化处理方,21,示教,查房：,查房病例特点,临床思维，诊治风格的展示,诊治技术，知识进展，交流沟通方式的,展示,规范医疗行为，照护好病人,培养,锻炼各级医生,主任或病房主任指导下的主治医负责制,主治医师,：甄选,、准备查房病例，提出查房目的，,文献查阅,专科医生、住院医生、研究生：准备查房,病例,呼吸与危重症医学科大查房,教学目的,示教查房：呼吸与危重症医学科大查房教学目的,22,查房,时间：每,周,一次，每次,2,小时,查房地点,：,查房室，配电脑、屏幕、,His,系统连接、网络、转播，等设备,参加人员,：各级,医师、研究生、实习医师、进修医师、护理人员及影像、病理等相关科室,人员,呼吸与危重症医学科大查房,规程,查房时间：每周一次，每次2小时呼吸与危重症医学科大查房规,23,4.,查房,病例,选择,：,疑难,或危重,病例,罕见病例,应用,新技术和新疗法的,病例,供,教学查房的典型,病例,选择,查房病例每次,12,例，病区,主治,医,/,主任负责,呼吸与危重症医学科大查房,规程,4.查房病例选择：呼吸与危重症医学科大查房规程,2