Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.
Objective To analyze the changing trends of economic operation indicators in public hospitals in Deyang City, explore the root causes of increasing operational pressure, and propose targeted countermeasures and suggestions. Methods Based on the annual health financial reports of 23 public hospitals in Deyang City from 2016 to 2024, the Joinpoint regression model was used to analyze the time-series trends of 20 economic operation indicators (covering four dimensions: revenue, operational efficiency, cost control and surplus capacity, and debt-paying ability). The annual percent change (APC) was calculated, and important turning points were identified. Meanwhile, a root cause analysis team was established. Fishbone diagram was used to analyze proximal causes from five aspects (man, machine, material, method, and environment), and the “5WHY method” was applied to trace the root causes. Results Among the 20 indicators, 6 showed significant changing trends. Total medical revenue continued to grow, but the growth rate slowed markedly after 2019 (P=0.035, APC decreased from 10.66 to 4.58). The average length of stay for discharged patients showed a trend of first increasing and then decreasing, with 2020 as the turning point (P<0.001, APC changed from 2.42 to ?4.79). The average medical cost per discharged patient shifted from growth to decline in 2020 (P<0.001, APC changed from 9.34 to ?4.57). Total medical activity costs continued to grow, and although the growth rate slowed after 2019 (P=0.027, APC decreased from 11.35 to 5.30), it remained higher than that of total medical revenue. The proportion of personnel expenses continued to grow, tending to flatten after 2018 (P=0.019, APC decreased from 3.91 to 0.79). Health materials consumed per 100 yuan of medical revenue first increased and then decreased, with 2022 as the turning point (P=0.008, APC changed from 1.90 to ?5.44). Root cause analysis showed that the root causes of increasing operational pressure were lack of overall planning for regional healthcare institutions, inadequate internal management level of medical institutions, revenue pressure brought by medical insurance fund management and payment reform, and defects in the medical service price adjustment mechanism that failed to fully reflect true value. Conclusion It is recommended that health authorities strengthen regional overall planning and functional positioning of medical institutions, medical institutions promote refined management and disease-based cost control, medical insurance departments improve the coordinated use and settlement mechanisms of insurance funds, and incorporate cost factors into the pricing mechanism and improve the dynamic adjustment mechanism.