Venous thromboembolism (VTE) is a high-risk complication in hospitalized patients, especially in patients with orthopedic surgery, neurosurgery, thoracic surgery, cardiac surgery and tumor surgery. It is also a significant cause of patients’ unexpected death and perioperative death. Through establishment of norms of VTE management system and organizational structure, formulation of perfect VTE risk assessment system and prevention and treatment scheme for hospitalized patients, training of all the medical staff for related knowledge, and test operation of the system in key departments, we established a hospital standardized system of venous thromboembolism prevention and management. Our VTE prevention and treatment work achieved good results through multidisciplinary collaboration.
ObjectiveTo explore the new hospital management method about diagnosis-related groups (DRGs), and put forward some strategic suggestions.MethodsIn March 2019, using literature research method, relevant documents were consulted to understand the research policy and background. In April 2019, the DRGs data and first pages of medical records of a tertiary grade A hospital in 2018 were obtained through field survey. The DRG with the largest quantity of patients was selected, and then the top two treatment centers ranked by the quantity of patients were selected for analysis.ResultsA total of 11 936 patients’ face sheets for medical records were investigated, covering 18 major disease categories (MDCs) and 93 DRGs. Treatment center A and B were the top two treatment centers ranked by the quantity of patients, covering 8 MDCs and 34 DRGs. There were 1 116 patients in treatment center A and 470 patients in treatment center B, with the same case-mix index (0.820). There was no statistically significant difference in the average length of hospital stay between the two treatment centers (t=−1.926, P=0.054). The average hospitalization expenses [(45 902.64±30 028.22) vs. (40 763.34±25 141.12) yuan, t=−3.260, P=0.001], drug expenses [21 481.43 (10 663.16, 34 251.64) vs. 11 740.36 (5 818.37, 21 572.09) yuan, Z=−9.812, P<0.001], and other expenses [138.00 (84.00, 178.00) vs. 120.00 (72.00,155.28) yuan, Z=−3.573, P<0.001] in treatment center B were higher than those in treatment center A. But the medical technology expenses [(7 319.11±3 781.52) vs. (10 995.61±4 784.55) yuan, t=12.324, P<0.001] and nursing expenses [(578.42±226.82) vs. (882.99±781.63) yuan, t=8.187, P<0.001] in treatment center B were lower than those in treatment center A.ConclusionsThe disease diagnosis and treatment specifications need to be strengthened and the process needs to be optimized. In the next hospital management, we should pay attention to key indicators to improve performance appraisal, standardize the diagnosis and treatment process to promote clinical path, and mine deep data to make performance management detailed.
ObjectiveTo explore the effect of perioperative fine management on patients undergoing video-assisted thoracoscopic surgery (VATS) for pulmonary nodule in day surgery mode.MethodsWe retrospectively analyzed the data of patients undergoing VATS for pulmonary nodule in Day Surgery Center of West China Hospital, Sichuan University between June 2019 and October 2020. The number of VATS procedures and general data of patients were collected. The effects of fine management on postoperative intrathoracic drain management, pain management, and diet management, as well as the postoperative follow-up and satisfaction survey were analyzed.ResultsA total of 162 patients were enrolled. The duration of postoperative chest drainage of 150 VATS patients who discharged from the hospital with normal extubation lasted for 5 to 22 h with an average of (10.88±3.54) h. Univariate analyses and multivariate logistic regression analysis showed that gender, age, method of surgery, and immediate postoperative pain score were not associated with delayed removal of thoracic drainage tube (>10 h) (P>0.05). The lowest score of numerical rating scale for pain intensity was 0 (painless) and the highest was 4 (moderate pain). After surgery, 12 patients (7.4%) were transferred out of the day surgery department, 2 patients (1.2%) were indwelled postoperative urinary catheter, 11 patients (6.8%) had unplanned revisit, and 6 patients (3.7%) had unplanned readmission. Patient satisfaction surveys were all satisfactory.ConclusionsThe implementation of fine management in VATS for pulmonary nodule in day surgery mode is beneficial for ensuring that patients can remove the drainage tube before discharge from the hospital, without severe pain after the operation and with good follow-up satisfaction.
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.
Hospital trusteeship means that the property owners of the hospital, through the form of contract and for the purpose of value preservation and proliferation, authorize a corporation or human being with strong administrative management capabilities and risk-bearing abilities to manage the hospital. With the deepening medical reform, the model has been gradually widely used. In this context, a well-known public hospital became the trustee of a newly established comprehensive private hospital. Taking the greatest advantage of its medical quality management, the trustee used SWOT (strengths, weaknesses, opportunities, and threats) analysis to develop efficient decision-making mechanism, strengthened the process optimization transformation, and improved the innovative means of information technology for the development of the new hospital, which has achieved very good results.
Under the background of promoting day surgery nationwide and ensure the medical quality, fine management is crucial and in trend. As one of the earliest central health organizations that started day surgery service in China, West China Hospital of Sichuan University has conducted approximate 140 000 day surgery cases in the past nearly 10 years. Based on the experience of practice, West China Hospital of Sichuan University has summarized 26 clinical indicators from 5 aspects to evaluate and monitor the economic efficacy and medical quality and safety of day surgery, including the input and output, the efficiency, the patient experience, the medical quality and safety, and the difficulty evaluation of surgery. The aim is to explore and establish an appraisal and monitoring system for day surgery, promote the stable development of day surgery, improve the work efficiency, and take the government plan of implementation day surgery to improve medical services into action.
The refined management of medical equipment archives is the key to its effectiveness. This article shares the practical experience of refined management of medical equipment archives in a tertiary hospital in Chengdu. Medical equipment archives are divided into paper archives and electronic archives, and the process of archive management collection, organization, identification, statistics, storage, and utilization is introduced. The article also discusses the construction, application, and management of archive management systems, aiming to provide a reference for solving the problems faced by refined management of medical equipment archives, achieving comprehensive and effective management of medical equipment archives, and significantly improving the level of archive utilization.
Objective To evaluate the effects of delicacy management applied in branch health management sub-center. Methods From July 2013 to December 2015, integrated delicacy management was applied throughout the whole process of the preparation for the establishment and the running of the branch health management sub-center. The strengths and weaknesses of the management, the management of the details and the control of the emphasis were analyzed. And the medical visits and incomes after the application of delicacy management were also analyzed. Results From July 2013 to December 2015, the monthly average medical visits were 1 870.17±609.93, 2 842.50±1 247.60 and 3 717.92±1 257.98, while the monthly average incomes were (2 136.0±585.1) thousand yuan, (3 620.5±1 559.9) thousand yuan and (4 921.1±1 837.2) thousand yuan, which increased significantly. Conclusion The application of delicacy management in the branch health management sub-center could ensure the quality of service, promote the steady growth of performance, and improve the understanding of the surrounding population of health management, thus we can improve the economic and social benefits of the health management sub-center.