Objective To explore the short-term effects of reengineering for the first-surgery preparation process in day surgery management. Methods In July 2019, West China Hospital of Sichuan University began to reconstruct a standard process for the first-surgery preparation process in day surgery based on the theory of process reengineering. Patients who underwent the first general anesthesia operation on the day at the Day Surgery Center between February and June 2019 were selected as the pre-reengineering group, and those between July and November 2019 were selected as the post-reengineering group. The time intervals for each stage of the surgical process and the incidences of delays in each stage were compared between the two groups. Results A total of 633 patients were included, with 309 in the pre-reengineering group and 324 in the post-reengineering group. The time from arrival to admission for the first patient [(30.24±7.86) vs. (22.45±10.65) min, P<0.001], time from admission to doctor’s orders [(9.42±7.07) vs. (5.45±5.86) min, P<0.001], waiting time before entering the operating room after nursing preparation [(23.67±17.59) vs. (18.46±19.60) min, P=0.001], and total waiting time from admission to entering the operating room [(73.42±18.46) vs. (65.27±21.00) min, P<0.001] in the post-reengineering group were all shorter than those in the pre-reengineering group. The incidence of patients admitted after 07:50 (2.3% vs. 0.3%, P=0.034) and the incidence of nurses’ preparation completion time extending beyond 08:20 (6.1% vs. 2.5%, P=0.022) in the post-reengineering group were lower than those in the pre-reengineering group. Conclusion The reengineering of the first-surgery preparation process significantly improves the management of day surgery across multiple stages of the process, reducing patient waiting times and minimizing delays in admission, order processing, and nursing preparations that may affect patients’ punctual entry into the operating room.
ObjectiveTo explore the safety of day surgery program of video-assisted thoracoscopy surgery in the treatment of pulmonary nodules.MethodsWe retrospectively analyzed the clinical features of the patients who received video-assisted thoracoscopy surgery between June and November 2019 in Day Surgery Center of West China Hospital, Sichuan University. The basic conditions, surgery duration, intraoperative blood loss, placement time of thoracic drainage, postoperative pain score, hospitalization expenses, and postoperative complications were observed. Postoperative telephone follow-up was conducted on the 2nd, 3rd, and 30th day after operation. The 1st day after operation means the next day after operation.ResultsA total of 29 patients were included with 5 males and 24 females. Surgeries were successfully performed on these 29 patients and they were all discharged as planned. The mean surgery duration was (78.14±16.37) min, the mean intraoperative blood loss was (38.15±23.04) mL, and the mean placement time of thoracic drainage was (577.45±233.70) min. Intraoperative open chest surgery and massive hemorrhage were not occurred. The Pain Numerical Rating Scale score at the 6th hour after surgery was 2.10±0.56, and the average hospitalization expense was (33 600±4 611) yuan. In the 29 patients, the postoperative complications included pneumothorax in 2, urinary retention in 1, tachycardia in 1, and persistent cough in 9. No recurrence of the listed complications was reported on the 30th day of telephone follow-up. No severe complications or postoperative death occurred.ConclusionDay surgery program of video-assisted thoracoscopy surgery is safe and effective in the treatment of pulmonary nodules.
Objective To investigate the safety and effect of same-day discharge in injection sclerotherapy for children with hemangioma (IJCH) and tension-free hernioplasty for adults with inguinal herinia (TFHA). Methods A retrospective analysis was conducted on patients undergoing IJCH or TFHA in the Day Surgery Center of West China Hospital of Sichuan University between November 2020 and October 2021. According to the patient’s condition and willingness, they were divided into same-day discharge group (162 children and 180 adults) and overnight hospitalization group (68 children and 271 adults). The amount of intraoperative bleeding, length of hospital stay, hospitalization expenses, pain before discharge, and short-term postoperative complications were compared between the two groups. Visual analogue scale was used for pain assessment in adults and children over 6 years old, and smiley face score was used in children below 6 years old. Results Compared with those in the overnight discharge group, the amount of intraoperative bleeding in the same-day discharge group was less [IJCH: (0.45±0.05) vs. (2.76±1.21) mL, P<0.05; TFHA: (1.20±0.05) vs. (6.76±2.30) mL, P<0.05], length of hospital stay was shorter [IJCH: (7.99±1.22) vs. (23.10±1.42) h, P<0.05; TFHA: (6.13±1.79) vs. (22.75±1.80) h, P<0.05], hospitalization cost was lower [IJCH: (5094.00±1320.14) vs. (6263.52±1220.20) yuan, P<0.05; TFHA: (7199.21±1535.84) vs. (7976.82±1967.82) yuan, P<0.05], pain before discharge was milder (IJCH: 0.05±0.02 vs. 0.50±0.01, P<0.05; TFHA: 1.20±0.01 vs. 2.01±0.20, P<0.05). There was no significant difference in the incidence of postoperative complications or unplanned revisit within 30 days between the two modes (P>0.05). Conclusions The same-day surgery mode is safe and feasible in IJCH and TFHA, and can shorten the length of hospital stay and reduce the cost of hospitalization. It is suggested to popularize this mode in clinical practice.