目的

探讨计划-执行-检查-处理（PDCA）循环在提升超声科住院医师外周血管超声图文报告质量中的应用价值。

方法

应用PDCA 质量控制管理方法，每月随机抽取2023 年1 月至7 月期间天津市第三医院住院医师在超声医学影像信息系统中的外周血管超声报告，评估报告的文字、图像质量。设置提升目标为甲类图文报告占比达到95%以上。成立持续质量改进小组，对于图文报告未达标的情况，分析存在的问题并制定改进措施。于2023 年8 月至12 月贯彻实施改进措施后，重新进行图文评分。采用χ² 检验比较实施前后图文评分和扣分项目的差异。通过持续推进培训学习、科内讨论、收集住院医师反馈的问题等确定阶段改进成果。

结果

PDCA 循环实施前，外周血管超声甲类图像占比为66.3%（130/196），甲类报告占比为44.9%（88/196）；实施后，甲类图像占比提高至95.8%（92/96），甲类报告占比提高至78.1%（75/96），图像和报告质量均显著提高，差异具有统计学意义（χ²=30.797，P＜0.001；χ²=28.849，P＜0.001）。PDCA 循环实施后，图像和报告扣分项目数量显著减少（45 项vs 102 项；59 项vs 164 项），检查者在仪器调节、疾病诊断描述和规范化存图能力等方面均有所提升。

结论

PDCA 循环在住院医师外周血管超声教学中的应用显著提升了图文报告质量。

Objective

To explore the application value of the plan-do-check-act (PDCA ) cycle in enhancing the quality of peripheral vascular ultrasound reports (including textual and imaging components)generated by resident physicians in the ultrasound department.

Methods

The PDCA cycle was implemented from January to July 2023.Peripheral vascular ultrasound reports produced by resident physicians were randomly sampled monthly from the Ultrasound Medical Imaging Information System of the Third Central Hospital of Tianjin.These reports were evaluated for textual clarity, image quality, and diagnostic accuracy.We set an improvement target of 95% or more for category A image and text reports and established a continuous quality improvement team to analyze deficiencies and develop corrective measures for substandard reports.After the implementation of the improvement measures from August to December 2023, the image and text scores were rescored.A chi-square test was used to compare the differences in image and text report scores and deficiency items before and after implementation.The improvement results were assessed through ongoing training implementation,discussion within the department, and feedback from resident physicians.

Results

Prior to PDCA implementation,category A images accounted for 66.3% (130/196) of reports, and category A reports constituted 44.9% (88/196).After PDCA intervention, category A images significantly increased to 95.8% (92/96), and category A reports improved to 78.1% (75/96).The enhancements in both image and report quality were statistically significant(χ²=30.797, P＜0.01; χ²=28.849, P＜0.01).After implementing the PDCA cycle, image and report deficiencies were significantly reduced (45 vs 102; 59 vs 164), and the ability of instrument adjustment, disease diagnosis and description, and standardized image storage were improved.

Conclusion

The PDCA cycle effectively improves the quality of peripheral vascular ultrasound reports.