Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
Due to optimizing medical service resources and improving service efficiency, day surgery has attracted the attention of medical and management experts worldwide. In 2019, day surgery was included as one of the performance assessment indicators of tertiary public hospitals. In recent years, hospital-based day surgery centers have begun to plan and build. Although the basic facilities have been perfectly improved, but how to efficiently and safely operate and manage the centralized day surgery has become the primary problem to clinicians and managers. The purpose of this paper is to introduce how the Day Surgery Center of West China Hospital of Sichuan University uses scientific management tools and establishes a professional multidisciplinary team, so as to carry out efficient operation management and control of medical quality and safety risks of the Day Surgery Center. And then provide practical experience guidance and suggestions with strong feasibility and operability for peers.
ObjectiveTo establish a systematic, scientific, and sensitive index system to provide a scientific basis for quality evaluation and comprehensive quality management of day surgery nursing.MethodsThe databases of Wanfang, China National Knowledge Infrastructure, CQVIP, PubMed, and Web of Science were searched. The retrieval time was from the establishment of the databases to 15th July, 2019. Based on the “structure-process-outcome” management model, Delphi method was used to conduct two rounds of expert consultation for nursing experts related to day surgery in five tertiary hospitals. The results of the consultation were sorted out and the consensus of experts was obtained, so as to determine the quality-sensitive indicators of day surgery nursing.ResultsA total of 20 nursing experts participated in the questionnaire survey. The final evaluation indicators determined by expert correspondence included 1 structural indicator, 9 process indicators, and 4 outcome indicators.ConclusionsThe construction of quality evaluation standard of day surgery nursing not only embodies the connotation of nursing management of day surgery, but also puts forward clear requirements and quality standards for specialized nursing management. It has high reliability, scientificity, and strong operability, which can effectively improve the quality of nursing management and service level of day surgery.
Day surgery is a new medical service model, which has developed rapidly in China because of its advantages of safety, efficiency and resource conservation. However, along with the rapid development in quantity, it also presents contradictions such as the mismatch with the previous surgical quality and safety management model, the urgent need for the unification of the new system of quality and safety evaluation indicators at the national level, and the imbalance in the construction of information technology of medical institutions in China, leading to the new problem of uneven quality control of day surgery. This article constructs a “five-in-one” new system for the quality and safety management of day surgery from the perspective of high-quality development, aiming to provide a theoretical basis for the formulation of relevant policies in China and to promote the safe, efficient, and orderly development of day surgeries.
Objective To analyze the causes of day surgery patients missing appointments, and discuss the countermeasures. Methods We selected the patients who had missed appointments for day surgery in the Second Affiliated Hospital Zhejiang University School of Medicine between January 2017 and June 2022. According to the implementation time of the measures, we divided the patients into two groups: pre-intervention (between January 2017 and June 2020) and post-intervention (between July 2020 and June 2022), to analyze the causes of patients’ cancellation, compare the change of patients’ cancellation rate before and after the implementation of measures, and explore the effectiveness of implementation measures. Results A total of 17 392 patients were included, and the total number of day surgery patients was 148 720 during the same period. The total cancellation rate was 11.69% (17 392/148 720). The cancellation rate in the post-intervention was lower than that in the pre-intervention [9.70% (7 935/81 775) vs. 14.13% (9 457/66 945), odds ratio was 0.695, 95% confidence interval (0.674, 0.717), P<0.001]. There were 13 common reasons for cancellation, of which “outpatient treatment, not hospitalization” was the most common reason. Conclusion Through the coordination of various departments, actively optimizing the preoperative evaluation of patients, updating the appointment process, strengthening effective communication and implementing the implementation of efficient medical treatment, the cancellation rate of day surgery can be reduced, which has certain reference significance to improving the management level of the hospital and the ability to serve patients.
ObjectiveTo explore the role of fast-track surgery (FTS) in day-case laparoscopic cholecystectomy (DLC) pain management. MethodsWe used bidirectional cohort study to investigate the patients undergoing day surgery of laparoscopic cholecystectomy admitted into our department. A total of 143 patients between April and September 2014 receiving routine pain management were chosen to be the control group, and 78 patients between October 2014 and January 2015 receiving FTS pain management were regarded as the FTS group. Postoperative pain, early ambulation, influence of pain on the sleep, patients' satisfaction and prolonged hospital stay rate were compared between the two groups. ResultsPain scores of patients in the FTS group 0-0.5, 0.5-6, 6-12, and 12-24 hours after surgery were significantly lower than those in the control group (P<0.05). The proportion of patients with early postoperative ambulation and patients' satisfaction rate in the FTS group were significantly higher than the control group (P<0.05). ConclusionThe FTS pain management model can effectively reduce patients' pain after DLC, accelerate patients' postoperative rehabilitation and increase patients' satisfaction.
Objective To explore the application of quality control circle in reducing the same-day cancellation rate of day surgery. Methods A quality control circle team was set up, and determined the theme of reducing the same-day cancellation rate of day surgery. A survey was conducted among all patients who had made appointments for day surgeries at the First Affiliated Hospital of the Air Force Military Medical University between August and October 2023. The number of patients who cancelled their surgeries on the day and the reasons for their cancellations were recorded. Based on the ten steps of the quality control circle, relevant measures and improvement processes were formulated. In March 2024, the same-day cancellation rate of day surgery after the quality control circle activity was analyzed. Results The same-day cancellation rate decreased from 2.39% to 0.67%, the target achievement rate was 135.43%, and the progress rate was 71.97%. Conclusion The quality control circle activity can effectively reduce the same-day cancellation rate of day surgery.
Day surgery dates back to 1909, when it was first performed by British paediatricians. Anesthesia management for day surgery requires quick onset, early recovery, rapid recovery, and few perioperative adverse reactions. Ensuring the medical safety of patients is the primary condition for the gradual implementation of day surgery. With the continuous development of medical level, the applicable field of day surgery has gradually expanded, and new concepts and progress have also emerged in anesthesia management. This article summarizes the relevant research at home and abroad, and reviews the new progress of anesthesia for day surgery from three aspects: preparation before anesthesia, selection of anesthesia methods, and recovery after anesthesia, in order to provide a reference for anesthesia management of day surgery.