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.
Objective To explore the effect of applying evidence-based medicine theory to quality management in long-term-system clinical medicine teaching. Methods We introduced the concept of evidence-based quality management system of clinical medicine to the delivery of teaching with Internet-based teaching quality real time supervision system as the core. A special quality scale was used to assess the teaching quality of teachers and the results were analyzed by SPSS 10.0 using u test. Results The system stored 853 280 pieces of data from the years 2001 to 2003. Up to 96.4% (275/285) of the evaluated topics scored over 85 points. Whether the teachers had overseas experience or not and whether their ages were over 45 or not had no significant influence on the teaching quality (P ＞0.05), but their degrees had influence on the teaching quality (P ＜0.05). Conclusion In long-term-system clinical medicine teaching quality management, we should apply the concept and approach of EBM to our practice so that we can ensure that the teaching quality of long-term-system clinical medicine will improve steadily.
ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
In 2021, West China Hospital of Sichuan University established a rare disease diagnosis and treatment and research center. The center adopts the rare disease management model of “one cohesion + four integration”, condenses the core of management, integrates clinical resources, regional alliance resources, training resources and research resources, and explores solutions for all-round services for patients with rare diseases. This article aims to explore the rare disease management model of regional central hospitals and introduces the above-mentioned rare disease management model. The purpose of this article is to promote this model, focus on the advantages of clinical departments and research institutes (offices), increase regional integration, give play to the synergy of regional alliances in clinical diagnosis and treatment and personnel training, and use international cooperation as an opportunity to promote breakthroughs in new drugs and technologies for rare diseases to benefit patients with rare diseases in China.
ObjectiveTo reduce patients' adverse events caused by needle indwelling through quality control circle (QCC) activities, in order to ensure the effectiveness and safety of intravenous fluids. MethodsGuided by the QCC theory, we set up QCC, selected the topic related to reduction of patients' adverse events caused by needle indwelling, and worked out the plans from September 2012 to April 2013. Then, we adopted Plan-Do-Check-Act (PDCA) cycle method to set up goals, formulate measures, and inspect and improve the results. ResultsThe incidence of needle-related adverse events reduced from 44.8% to 9.8% by implementation of quality circle activities. There was a significant statistical difference between the two groups (χ2=148.16, P<0.05). ConclusionQCC activity can not only reduce the adverse events incidence of needle indwelling, but also improve the nurses' working enthusiasm and responsibility, problem-solving skills and accomplishment, and promote team cohesion.
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.
Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.