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.
ObjectiveTo explore the management experience of day surgery in children specialized hospitals.MethodsWuhan Children’s Hospital began one-day pediatric surgery in 1981. In 2001, one-day surgery center was formally established to centralize treatment and management. In the past three years, the mixed management of centralized and decentralized treatment was increased. At the same time, the one-day surgery management process was optimized, the relevant access and evaluation system was strictly implemented, to ensure the medical quality and medical safety.ResultsSince 2001, more than 120 000 cases of day surgery had been performed in the hospital, without death or other serious complications. The incidence of common postoperative complications was less than 0.8%, and the time of occurrence of complications was mainly within 12 hours after surgery. By 2018, the number of day surgeries in the hospital accounted for 29.57% of the annual elective surgeries, and the overall incidence of complications was lower than the traditional hospitalization mode of the same disease.ConclusionsThe concept of patient-centered service is truly embodied in day surgery. Specialized hospitals, especially children’s hospitals, have a large number of single diseases, a large demand for patients’ surgeries, a high degree of homogeneity of surgeries, good surgical results, and urgent needs and advantages to carry out day surgery. Day surgery is suitable to start in developed departments, and be promoted in other specialties of the hospital when experience has been accumulated, so as to increase the proportion of day surgery in elective surgery gradually.
ObjectiveTo carry out health education to day surgery patients, assist the smoothness of their operation, promote early recovery of patients and improve the quality of nursing and patients' degree of satisfaction. MethodsA total of 1 888 operations from January to May, 2013 were chosen to be the control group; and 2 136 operations from January to May, 2014 were regarded as the trail group. Patients in the control group accepted routine nursing and health education, while patients in the trail group accepted health education before and after surgery, and through telephone during the follow-up period. ResultsThe rate of failure to keep the appointment, the readmission rates, and the satisfaction rate to the nursing work were 0.28%, 0.94% and 94.71% respectively in the trial group, while were 3.50%, 3.07%, and 90.20%, respectively in the control group. the differeces between the two groups were significant (P<0.05). ConclusionPersonalized health education can ensure the smooth operation of day surgery, advance wound healing of the patients, and improve the day surgery ward care quality and patient satisfaction.
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.
ObjectiveTo investigate the effect of quality control circle (QCC) activity in reducing the temporarily stopping rate of day surgery.MethodsThe QCC activity was carried out from December 2018 to October 2019. By determining the theme of the activity and drawing up the plan, a retrospective analysis of pre-hospital day surgery stoppage status and reasons was performed based on 2 696 patients who had reserved surgery in the day surgery center from December 2018 to February 2019. Based on the data, the goal was determined, and measures were developed and confirmed from May to August 2019. Then the measures were standardized and implemented continuously from September to October 2019. The rate of surgical cessation before the implementation of the measures (from December 2018 to February 2019) was compared with that after the implementation of the measures (from September to October 2019).ResultsAfter the QCC activity, the temporarily stopping rate decreased from 2.89% to 1.34%, and the difference was statistically significant (P<0.001).ConclusionThe QCC activity can effectively reduce the temporarily stopping rate of day surgery, and lay the foundation for continuously promoting the optimization of day surgery resources and quality improvement.
Day surgery wards have advantages such as the ability to quickly free up beds and possessing necessary medical resources, making them a focal department for the integration of emergency and routine medical care within healthcare institutions. The Day Surgery Nursing Committee of Sichuan Tianfu New Area Medical Association gathered experts from relevant fields, took into account the actual situation and previous practices of integrating emergency and routine medical care in day surgery wards, and developed this expert consensus. It covers the aspects of emergency plans, process mechanisms, spatial preparations, personnel preparations and deployment, material preparations, and information sharing and coordination of the management model of integrating emergency and routine medical care in day surgery wards, so as to provide professional guidance and references for the management model of integrating emergency and routine medical care in day surgery wards, and offer new ideas and methods to maximize patient treatment during emergency situations.
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.
Day surgery has been applied in practice since more than 30 years ago in western world, which could obviously reduce the length of hospital stay, accelerate the recovery of patients, and achieve desirable economic and social benefits. Despite of the common development of day surgery in various diseases, the application of day surgery in breast general anesthesia surgery is limited. No related management standard has been established. By summarizing the experience of breast cancer day-surgery, Xijing Hospital of Air Force Medical University has established a comprehensive management standard, including preoperation, intraoperation, and postoperation management. Meanwhile, the nursing, resource allocation, follow-up, and stuff management are all enrolled into the management standard, aiming to improve the development of day surgery in general anesthesia breast cancer operation.
ObjectiveTo develop a patient satisfaction evaluation scale for day surgery and test its reliability and validity, so as to provide a scientific and effective tool for day surgery patient satisfaction assessment.MethodsThe literature review method was used to form an entry pool, and the initial version of the scale was formed in conjunction with the expert review method. And then a preliminary survey was conducted to obtain the tentative version of the scale. Finally, 290 day surgery patients discharged between June 15th and July 15th, 2019 were selected to accomplish a survey to check the reliability and validity of the scale.ResultsFinally, a day surgery patient satisfaction evaluation scale was formed, containing 3 stages (pre-hospital, hospitalization, and postdischarge follow-up), 3 dimensions (medical staff evaluation, medical service evaluation, and environment and process evaluation), and 40 items. After the formal survey, the overall Cronbach’s α coefficient of the scale was 0.980, the Spearman-Brown coefficient was 0.933, the Guttman’s half-coefficient was 0.932, and the content validity was 0.87-1.00.ConclusionThe day surgery patient satisfaction evaluation scale was proven good reliability and validity, which can be used as a measurement tool for day surgery patients and applied to clinical practice.