关键词: JCI标准, 手术/有创操作, 安全核查, 流程再造

Abstract: Objective：To investigate how to reengineer the process of safety verification of surgical/invasive procedure and extend of the application according to the JCI standards. Methods： The International Patient Safety Goals (IPSG.4) was conducted to reengineer the process of the surgical/invasive procedure safety verification. Trainings were organized for medical staffs to familiarize with the process and abide by the standards. The Plan-Do-Check-Action (PDCA) management tools practically used for quantitative assessment，supervision，and inspection. Results： The implementation rate was increased from 52.1% to 99.5% and the qualified rate from 44.9% to 97.6%（P<0.001），through three rounds of PDCA cycle. The statistical differences were significantly indicated and achieved of the aims of the IPSG.4. Conclusion： JCI standards combined with the application of management tools were revealed of the improvement of the qualification rate of the surgical/invasive procedure safety verification, and preclude of the errors of the correct-patient surgery， site，and procedure.

Key words:  , JCI standard；surgical/invasive procedures；safety verification；process reengineering