Effect of Quality Management Improvement on the Home Page of Inpa-tient Medical Records
Objective To study the effect of improving the quality management of the first page of inpatient medical records.Methods 11 staff from the medical records room of the Second People's Hospital of Xinhui District,Jiangmen City were selected as the study subjects,and the regular quality management of inpatient medical records was imple-mented from January to June 2022 before the implementation,and the quality management of the inpatient medical re-cords was strengthened from July to December 2022.Compare the overall improvement of the quality of medical re-cords before and after the implementation of the staff to strengthen the quality management of the first page of inpa-tient medical records.Results After the implementation,the writing quality score was significantly higher than that be-fore the implementation,and the difference was statistically significant(P<0.05);the number of missing items such as basic information,diagnosis and treatment information,and the time of submission and filing of inpatient medical re-cords were all better after the implementation than before the implementation,and the differences were significantly different(all P<0.05);the proportion of the main diagnosis and the number of correct diagnoses with other diagnoses was slightly higher after the implementation than before the implementation,but the differences were not statistically significant(both P>0.05).Conclusion Strengthening the quality management of the first page of inpatient medical re-cords under the related groups of disease diagnosis can significantly improve the integrity and accuracy of the first page of medical records,which is conducive to improving the quality of medical records.
Home page of inpatient medical recordsQuality managementMedical record management
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