探讨东莞市二级及三级医院超声医学质量管理现状及面临的主要问题。

调查与分析2020年1月1日至12月31日东莞市52家二级医院（31家）及三级医院（21家）超声基线情况与质量指标，采用χ²检验比较二级医院与三级医院超声基线情况（工作人员、医师年龄、医师职称、医师学历）的差异，采用秩和检验比较质量指标（结构质量分析指标、过程质量分析指标、结果质量分析指标）的差异。

在超声基线情况的比较中，工作人员、医师年龄、医师学历差异均有统计学意义（χ²=15.499、8.418、95.375，P=0.001、=0.038、＜0.001），而医师职称差异无统计学意义（P＞0.05）；在结构质量分析指标中，二级医院与三级医院平均每日门诊、急诊、体检、住院超声检查人次及超声科医患比比较［183.94（107.14，266.11）人次/d vs 383.85（174.19，557.50）人次/d；19.02（6.03，25.37）人次/d vs 24.72（5.32，36.51）人次/d；27.66（8.76，36.90）人次/d vs 50.94（30.29，115.29）人次/d；49.55（32.96，69.94）人次/d vs 84.80（43.76，303.47）人次/d；1.24（0.96，1.64）人/万人次 vs 0.89（0.79，1.18）人/万人次］，差异有统计学意义（U=176.000、141.000、141.000、196.000、203.000，P=0.005、0.002、0.002、0.016、0.022），而超声科医师数与超声诊断仪器台数比差异无统计学意义（P＞0.05）；在过程质量指标分析中，二级医院与三级医院平均住院超声预约时间及危急值通报例数比较，差异均无统计学意义（P均＞0.05）；在结果质量指标分析中，二级医院与三级医院超声诊断符合率比较［90.00（78.50，92.10）% vs 90.85（88.00，95.00）%］，差异有统计学意义（U=150.000，P=0.038），而超声报告阳性率比较差异无统计学意义（P＞0.05）。

东莞市三级医院超声医师紧缺，需进一步增加人员，加强人才队伍建设，缓解医患供需关系紧张。相比之下，东莞市二级医院超声医师学历较低，应鼓励毕业后再教育，提高主体医师的教育水平。未来，东莞市超声医学质量控制中心还应结合各个医院超声质量控制情况，制定符合本市的超声质量控制程序、标准和计划。

To explore the main problems in ultrasound departments of secondary and tertiary hospitals in Dongguan according to their basic situations and quality control indexes.

Basic situations and quality control indexes of ultrasound departments were surveyed and analyzed in 21 secondary hospitals and 31 tertiary hospitals in Dongguan, China from January 1, 2020 to December 31, 2020. The differences of basic situations (staff of ultrasound departments, age of ultrasonic doctors, professional title of ultrasonic doctors, and educational qualification of ultrasonic doctors) were compared between secondary hospitals and tertiary hospitals by using by chi-square test. The rank sum test was used to compare the differences of quality control indexes (structural quality indexes, process quality indexes, and result quality indexes) between secondary hospitals and tertiary hospitals.

Regarding basic situations, there were statistically significant differences in the staff of ultrasound departments, age of ultrasonic doctors, and educational qualification of ultrasonic doctors between secondary hospitals and tertiary hospitals (χ²=15.499, 8.418, and 95.375, P=0.001, =0.038, and ＜0.001, respectively). However, the professional title of ultrasonic doctors had no statistically significant difference (χ²=3.674, P＞0.05). With regard to quality control indexes between secondary hospitals and tertiary hospitals, structure quality indexes including the average daily ultrasound examination amount in outpatients, emergency cases, cases of physical examination, cases of in-hospital ultrasound examination, and the ratio between the number of ultrasonic doctors and patients [183.94 (107.14, 266.11) patients/day vs 383.85 (174.19, 557.50) patients/day; 19.02(6.03, 25.37) patients/day vs 24.72 (5.32, 36.51) patients/day; 27.66 (8.76, 36.90) patients/day vs 50.94 (30.29, 115.29) patients/day; 49.55 (32.96, 69.94) patients/day vs 84.80 (43.76, 303.47) patients/day; 1.24 (0.96, 1.64) per ten thousand patients vs 0.89 (0.79, 1.18) per ten thousand patients] exhibited statistically significant differences (U=176.000, 141.00, 141.000, 196.000, and 203.000, P=0.005, 0.002, 0.002, 0.016, and 0.022, respectively), while the ratio between the number of ultrasonic doctors and diagnostic instruments had no statistically significant difference (U=265.000, P＞0.05). For process quality indexes, neither the average inpatient ultrasound appointment time nor the cases with ultrasound critical value report showed a statistically significant difference (U=313.000 and 239.500, respectively, P＞0.05). Regarding result quality indexes, the compliance rate of ultrasound diagnosis [90.00% (78.50%, 92.10%) vs 90.85% (88.00%, 95.00%)] had a statistically significant difference (U=150.000, P=0.038), but the positive rate of ultrasound reports had no statistically significant difference (U=301.000, P＞0.05).

In order to solve the main problems that ultrasonic doctors are urgently needed in tertiary hospitals and poorly educated in secondary hospitals in Dongguan, the ultrasound departments should recruit new staff and reeducate them after graduation. In the future, the government should formulate policies to improve the quality of ultrasound departments based on their own characteristics.