Objective To evaluate the refined management effect of diagnosis related groups (DRG), summarize the experience of refined management, and put forward corrective measures for existing problems. Methods Patients who underwent day surgery services at Shantou Central Hospital between April 2021 and March 2023 were selected. According to the management mode, patients will be divided into a conventional management group (April 2021 to March 2022) and a refined management group (April 2022 to March 2023). The general condition, medical quality, and patient satisfaction indicators of two groups of patients were compared. And according to the DRG group stratification, the differences in medical indexes such as length of hospital stay, total hospitalization expenses, and postoperative complications between the two groups were analyzed. Results A total of 4 584 patients were included, including 1 686 in the conventional management group and 2 898 in the refined management group. There were statistically significant differences between the two groups in terms of patient source, surgical grade, and provincial weight coefficient (P<0.05). However, there was no statistically significant difference in gender, age, and discharge method (P>0.05). The satisfaction of the refined management group with surgical procedures, preoperative guidance, service attitude, and nursing skills was higher than that of the conventional management group (P<0.05). A total of 4 DRG groups (≥ 100 patients) were included, with 2 215 patients in the refined management group and 1 460 patients in the conventional management group. Among them, there were 1496 cases in the group CB39 (cataract surgery), 336 cases in the group GE10 (inguinal and abdominal hernia surgery, age<17 years old), 1412 cases in the group JB29 (partial mastectomy for non-malignant breast tumors), and 431 cases in the group NE19 (vulvar, vaginal, and cervical surgeries). Among them, in the group CB39 (cataract surgery), group GE10 (inguinal and abdominal hernia surgery, age<17 years old), group JB29 (partial mastectomy for non-malignant breast tumors), and group NE19 (vulvar, vaginal, and cervical surgeries), the total hospitalization cost and length of stay in the refined management group were lower than those in the conventional management group (P<0.05). In the group CB39 (cataract surgery) and group NE19 (vulvar, vaginal, and cervical surgeries), the incidence of postoperative complications in the refined management group was lower than that in the conventional management group (P<0.05). In the group GE10 (inguinal and abdominal hernia surgery, age<17 years), the incidence of pain and incision bleeding in the refined management group was lower than that in the conventional management group (P<0.05); In the group JB29 (partial mastectomy for non-malignant breast tumors), the incidence of incision infection in the refined management group was lower than that in the conventional management group (P<0.05). There was no statistically significant difference in other indicators between the two groups (P>0.05). Conclusion Carrying out refined management for day surgery can reduce medical expenses, shorten the length of hospital stay, improve medical quality, and promote the high-quality development of hospitals while ensuring medical safety.
Day surgery has been developed in China for over 30 years. However, the admission decisions for day surgery patients are still mainly based on expert experience, brainstorming, and institutional recommendation, and lack scientific admission criteria and universality. West China Hospital of Sichuan University has implemented methods such as semi-supervised learning based on heterogeneous data, to construct a more objective and accurate patient admission model based on large amounts of diagnosis and treatment data. This initiative aims to assist the country and hospital in reducing medical costs and alleviating the acute problem of the current contradiction between supply and demand of medical resources. It also seeks to optimize the utilization and allocation of bed resources, reduce the cost of patient management, enhance the theoretical research on patient admission methods in day surgery in China, and provide reference and inspiration for other hospitals in the day surgery industry in China.
ObjectiveTo explore the application of artificial intelligence in postoperative follow-up of day surgery patients, so as to establish an intelligent medical framework, promote the intelligent process of hospitals, and improve the management level of day surgery.MethodsThe artificial intelligence phonetic system was carried out by the Day Surgery Center, Renji Hospital, Shanghai Jiaotong University School of Medicine on June 1st, 2018. Through the system, the artificial intelligence voice system based on speech and semantic recognition technology was adopted to connect the data of the information center in the hospital to carry out postoperative follow-up of day surgery patients. We selected the 2 245 patients followed up by the artificial intelligence phonetic system from June 1st to November 30th 2018 (the AI follow-up group) and the 2 576 patients followed up by the traditional manual method from January 2nd to May 31st 2018 (the manual follow-up group), to compare the telephone connection rate, information collection rate, and call duration between them.ResultsThere was no statistically significant difference in telephone connection rate (85.70% vs. 86.68%) or information collection rate (98.86% vs. 98.48%) between the AI follow-up group and the manual follow-up group (P>0.05); but there was a statistically significant difference in call duration between the AI follow-up group and the manual follow-up group [(165.48±43.28) vs. (135.37±36.31) seconds, P<0.05], and the AI follow-up group had a longer call duration.ConclusionsThe application of artificial intelligence phonetic system in surgery has a good performance in call connection rate and information collection integrity. It plays an active role in improving efficiency, extending medical services and strengthening medical safety in the management of day surgery.
Objective To explore the application effects of innovative health education on patients undergoing ambulatory laparoscopic cholecystectomy (LC). Methods A total of 139 patients undergoing ambulatory LC from November to December 2016 were selected as the control group, receiving the traditional health education; and other 141 patients undergoing ambulatory LC from February to March 2017 were selected as the observation group, receiving the innovative health education. The two groups were followed up and observed 1 day, 2, and 28 days after the discharge, and the incidence rates of adverse reactions such as postoperative pain, bleeding and incision infection were measured, and the disease knowledge mastery, self-care skills, medication compliance and satisfaction to nursing and hospital were evaluated. Results The total incidence rate of adverse reactions was 7.8% in the observation group and 25.2% in the control group (P<0.001). Medication compliance from high to low was 90, 46 and 5 cases in the observation group and 59, 64 and 16 cases in the control group (P<0.001). In the observation group, the scores of disease knowledge mastery, self-care cognition, nursing satisfaction and hospital satisfaction were 93.4±5.5, 91.4±4.5, 96.4±3.7 and 98.1±3.7, respectively, which were higher than those in the control group (83.8±8.7, 83.2±9.1, 91.5±9.2 and 94.8±7.3, respectively) with statistical significance (P<0.001). Conclusion Innovative health education has certain application effects on ambulatory LC, and it can significantly improve disease knowledge mastery and self-care cognition, and help to ensure the medical quality and safety during perioperative period, and improve the patients’ satisfaction.
Total hip arthroplasty is an end-stage treatment for hip diseases such as hip osteoarthritis and osteonecrosis of the femoral head. Traditional surgery models are still mostly used in China, and related day surgery models abroad have shown that day surgery for total hip arthroplasty is as safe and feasible as traditional pattern without increase in complications and readmission. It can also shorten the length of hospitalization for patients, reduce hospitalization costs, thereby speeding up bed turnover and increasing the utilization of medical resources. This article reviews the patient admission, perioperative management, anesthesia and surgical techniques, post-discharge rehabilitation and nursing care of patients undergoing day surgery for total hip arthroplasty, and aims to providea reference for the development of day surgery for total hip arthroplasty in China.
Taking the Breast Surgery Department of the Second Affiliated Hospital Zhejiang University School of Medicine as an example, this paper introduces the quality management experience of day surgery case settlement checklist. Through the establishment of diagnosis-related groups (DRGs) settlement checklist quality control review mechanism, the introduction of DRGs information system to monitor the quality of settlement checklist in real time, and strengthening the supervision of low-rate cases and other measures, the quality of medical insurance fund settlement checklist and the accuracy of case enrollment have been effectively improved, and the occurrence of low-rate cases has been reduced. On the whole, day surgery and DRGs payment jointly promote the effective improvement of medical service efficiency and the reasonable allocation of medical resources, and reduce the average cost per patient and the average length of hospital stay.
Objective To analyze the influencing factors of unplanned readmission for day surgery patients under the centralized management mode, and to provide a scientific basis for improving the medical quality and safety of day surgery. Methods The data of patients in the day surgery ward of the Second Affiliated Hospital Zhejiang University School of Medicine between October 2017 and October 2021 were retrospectively collected, and they were divided into an unplanned readmission group and a control group according to whether they were unplanned readmission within 31 days. Multivariate logistic regression model was used to analyze the influencing factors of patients’ unplanned readmission within 31 days. Results There were 30 636 patients, of which 46 were unplanned readmission patients, accounting for 0.15%. Logistic regression analysis showed that male [odds ratio (OR)=0.425, 95% confidence interval (CI) (0.233, 0.776), P=0.005], thyroid surgery [OR=19.938, 95%CI (7.829, 50.775), P<0.001], thoracoscopic partial lobectomy [OR=13.481, 95%CI (5.835, 31.148), P<0.001], laparoscopic cholecystectomy [OR=10.593, 95%CI (3.918, 28.641), P<0.001] and hemorrhoidectomy [OR=13.301, 95%CI (4.473, 39.550), P<0.001] were risk factors for unplanned readmission in patients undergoing day surgery. Conclusion Medical staff in day surgery wards need to strengthen supervision of male patients and high risk surgical patients, and improve patients’ awareness of recovery, so as to reduce the rate of unplanned readmission.
The traditional view is that breast reconstruction is not an option for day surgery center. As a result, few hospitals in the world conduct this operation in day surgery center. Endoscopic breast reconstruction with liposuction and robot-assisted breast reconstruction are minimally invasive surgeries for breast cancer patients, but they cannot be carried out in the day surgery center due to long operation time. The novel endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy through a single axillary incision for breast cancer patients has been successfully conducted in the day surgery center in our hospital due to short operation time and small trauma. Standardized management of the complete process from the patient selection to follow-up after discharge brings rapid recovery and few complications. At the same time, the development of endoscopic surgery makes the breast almost scarless and improves aesthetic results. Therefore, the mode of endoscopic-assisted reconstruction in the day surgery center of our hospital is expected to be popularized in the whole country.