In recent years, day surgery has developed rapidly in China. It is very important to ensure the medical quality and safety of day surgery patients post-discharge. However, there are no regulations, guidelines or policy on the quality and safety of medical care post-discharge in China yet. As one of the medical institutions which are the earliest to carry out day surgery in a standardized way in China, West China Hospital of Sichuan University has summarized the nearly 10 years’ experiences in day surgery, and formulated management norms after discharge of day surgery, including discharge evaluation, discharge guidance, follow-up after discharge, and emergency plan. This paper introduces the management norms for day surgery post-discharge from West China Hospital ofSichuan University, in order to provide reference for the management of the day surgery patients post-discharge medical care in China.
Day surgery has become an international and domestic medical service model, and it has received more and more attention from hospital administrators in terms of innovation and practical benefits for hospital management. However, from the perspective of standardization management, management norms have still been wanted. This paper introduces the general specification of clinical pathway management for day surgery in West China Hospital of Sichuan University, in order to provide reference for subsequent research, and hopes to provide certain standard models to provide reference for clinical pathway management practice.
Day surgery mode is a challenge for surgeons, anesthesiologists, nurses, and managers. Standardized management should be implemented in each management model, no matter centralized management or decentralized management model, by utilizing the theory of enhanced recovery after surgery and information management to establish a system to ensure patient’s safety and medical quality. Only in this way the development of day surgery will be healthy and sustainable.
This article discusses the concret implementation of day surgery in Ophthalmology Center, Beijing Tongren Hospital, Capital Medical University during the coronavirus disease 2019 epidemic and under the regular prevention and control, so as to provide a basis for ensuring the safety and effectiveness of clinical work in the special period. According to the requirements of health administration departments and the hospital for the prevention and control of epidemic, combining with the characteristics of concret work, the Ophthalmology Center carried out and accurately implemented a series of prevention and control management measures, and obtained good results in the clinical work on the basis of comprehensive security protection. From February to October, 2020, there were a total of 16 507 cases who underwent the day surgery in the Ophthalmology Center, with no surgical infection or suspected case of coronavirus disease 2019. The safety and quality management of epidemic prevention and control has played an active and effective role in the active development of day surgery in this center. The safe and optimized diagnosis and treatment process has reassured the patients and their families, and the strict implementation of protective measures by medical staff has ensured the safety of surgery and the work being proceed with smooth progress and high efficacy.
Since its establishment in 2009, adhering to the concept of patient-centered service, the Day Surgery Center of West China Hospital of Sichuan University has been improving the management model constantly, and perfecting the service process gradually, to ensure the medical quality and safety of the hospital, and optimize the utilization of medical resources. In view of the management of day surgery, the hospital has formulated a sound patient access system, surgeon access principle, standardized appointment process and contingency plans, and made changes in patient admission process, responsibilities of surgeons, and nursing care comparing with the traditional hospital operation. The purpose of this paper is to introduce the management model of day surgery in West China Hospital of Sichuan University, discuss the clinical application of centralized and decentralized management in combination with the actual situation, and explore the model of day surgery with high applicability and more consistent with our national conditions.
Day surgery is regarded as a breakthrough in promoting the construction of hierarchical diagnosis and treatment because of its advantages such as effectively shortening the length of hospital stay and making full use of medical resources. In order to comply with the national policies, medical development, patient needs, and other factors, as a comprehensive tertiary hospital, Zhengzhou Central Hospital Affiliated to Zhengzhou University taking regional synergy as a carrier, combining with 92 medical units, actively explores the rational flow of patients with day surgery in the region, through implementing clinical path management, controlling surgery expenses and drug and consumables proportions, purchasing medical health insurance for day surgery patients to ensure patient safety, opening a green channel for patients at the grassroots level, effectively using the medical insurance to co-ordinate funds, and rationally planning medical treatment procedures, ect.
Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.
With the rapid development of day surgery mode in China, day surgery management has shifted from extensive to refined, but there are still many problems in the information system of day surgery in Chinese hospitals. The Second Affiliated Hospital Zhejiang University School of Medicine has developed a day surgery information management system since 2018, established a pre-hospital and in-hospital day surgery ecological management, and integrated daily management concepts and management rules into the system through the whole-process information management. It realized the whole process, full data, closed-loop and path-based information management of day surgery. This paper introduces the day surgery information management system of the Second Affiliated Hospital Zhejiang University School of Medicine, and aims to share the experience of building the day surgery information management function module.
In recent years, day surgery has developed rapidly in China, but there is still a certain gap between domestic and international fields. The whole-process perioperative analgesia management standard is one of the necessities to ensure the rapid recovery and timely discharge of patients undergoing day surgery, and it is also an effective driving force to narrow the gap between domestic and international day surgery management. Based on the clinical experience of perioperative analgesia management for day surgery patients in West China Hospital of Sichuan University, this paper summarizes the implementation strategies, quality control of perioperative analgesia management and the construction of painless day surgery ward, and formulates the perioperative analgesia management standard for day surgery, which will provide a reference for the perioperative analgesia management for day surgery in China.
ObjectiveTo investigate the preoperative cognition of the patients undergoing daytime ophthalmic fundus surgery and understand their needs of health education, so as to provide an evidence for efficient and accurate preoperative health education services within the limited time of the ophthalmic day fundus surgery.MethodsThe convenient sampling method was used to select the patients who met the inclusion criteria in the ambulatory operating room of Beijing Tongren Hospital, Capital Medical University from December 2017 to May 2018. The study included three parts: the general information of the patients, the preoperative cognition of the patients, and the needs for health education service of the patients. Questionnaires were designed according to the research purpose and method, which were distributed and recovered by professionals.ResultsA total of 112 patients were included. Among them, the cognitive scores of operation process (2.57±0.56), preoperative diet (2.58±0.59), preoperative medication (2.60±0.64), and psychological status (2.58±0.65) were relatively low. More health education services were needed in three aspects: the cognition of operation details [operation duration (85.71%), surgeons (79.46%), operation start time (76.79%)], intraoperative cooperation (90.18%), and intervention for preoperative anxiety (78.57%).ConclusionNurses should formulate the contents of preoperative health education according to the preoperative cognition and nursing needs of patients, so as to provide efficient and accurate health education services for patients.