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.
Based on the practice of large tertiary hospitals in clinical pathway (CP) entrance management, we implemented a fine CP management model with standardized clinical diagnosis and treatment, and encouraged the department to continuously optimize the path form, expand CP coverage and improve the entry rate in a flexible path. Combining PDCA cycles with CP management, it can promote the realization of management goals and achieve continuous improvement, while providing operable (repeatable) methods to the practice of hospital CP management.
Objective To evaluate the feasibility of the clinical pathway based on the medical data information integration system to guide the treatment of palmar hyperhidrosis (PHH). Methods We retrospectively analyzed the clinical data of 106 PHH patients in the Fourth Affiliated Hospital of Harbin Medical University from March 2012 through June 2015. The patients were divided into two groups including a day surgery group (52 patients) and a traditional group (54 patients). The patients in the day surgery group underwent day surgery guided by clinical pathway of PHH based on medical data information integration system. The patients in the traditional group stayed in hospital for 2-3 days. The pre-surgical situation, post-surgical effect of patients and cost of hospitalization were compared between the two groups. Results Only one patient of PPH suffered from insufficient relief of symptoms. The other patients’ symptom of PPH disappeared. No serious complication occurred. The postoperative visual analogue scale (VAS) pain score of patients was lower than 2 points. The hospitalization expense of the day surgery group was significantly lower than that of the traditional operation group. The average follow-up time was 2.5 months (0.5 to 4 months). The symptoms of the whole group had no recurrence. All of the patients were not found with compensatory hyperhidrosis. Conclusion Day-surgery clinical pathway of PHH based on medical data information integration system is safe and feasible. Day-surgery clinical pathway of PPH can accelerate the recovery of patients and save the cost of hospitalization.
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.
Objective To investigate the efficacy of improved clinical nursing path for day surgery of laparoscopic cholecystectomy (LC). Methods The clinical data of 3 274 patients who underwent day surgery of LC following the clinical pathway between January 2011 and December 2015 were collected. The rate of adverse events including pain, postoperative nausea and vomiting (PONV), retention of urine and staxis before and after the improvement of clinical nursing path was analyzed and compared. Results For adverse event rate before and after the improvement of clinical nursing path, the difference in the incidence of pain and PONV was statistically significant (P < 0.05), while the difference in retention of urine and staxis was not statistically significant (P > 0.05). Conclusions Through the improvement of clinical nursing path for LC during day time, the procedure of nursing becomes more standardized. It is more feasible for clinical work and postoperative adverse reactio n rate becomes lower. It can also help shorten postoperative rehabilitation time and ensure perioperative medical quality and safety.
ObjectivesTo analyze the citation of evidence in traditional Chinese medicine (TCM) clinical pathways in China, and to provide suggestions for future development and revision of TCM clinical pathways.MethodsTCM clinical pathways released on the websites of national administration of TCM and China association of Chinese medicine were obtained, with the retrieval time limit to June 2019. Two researchers separately utilized the Excel to extract data and performed a descriptive analysis.ResultsA total of 405 TCM clinical pathways were included, involving internal medicine, surgery, gynecology and pediatrics. Internal medicine accounted for the largest proportion of the TCM clinical pathways (133). All the 405 pathways cited references as evidence, among which the maximum and minimum quantities of cited references were 11 and 1, respectively, and the median was 3. More than 90% of the TCM clinical pathways cited the evidence in the parts of diagnosis and efficacy evaluation. For parts of TCM and western medicine treatment, the proportion of TCM clinical pathways which cited evidence was less than 75%; for parts of rehabilitation and nursing, the proportion of TCM clinical pathways which cited evidence was less than 2%. The types of evidence being cited were standard indicators (683), clinical practice guidelines (488), textbooks (236), consensus opinions, ancient books and clinical surveys. The released time was reported in 89.25% of the cited evidence; the largest time interval was between the release time of the standard indicators (evidence) and that of the TCM pathways. Among the evidence released more than 15 years before the release of the TCM pathways, the proportion of standard indicators was the highest (57.12%).ConclusionsThe published TCM clinical pathways are all developed based on evidence, however, the evidence citation ratio in different parts varies greatly. In some TCM clinical pathways, the cited evidences are not reported normatively, and some evidence are poor in timeliness.
Objective To systematically evaluate the association between Caveolin-1 and gastric cancer, as well as its clinical pathologic features. Methods Databases including Wanfang, VIP, CNKI and PubMed were searched to identify case-control studies involving the association between Caveolin-1 and gastric cancer as well as its clinical pathologic features from January 2000 to May 2017. The literatures were screened and the methodological quality was assessed, then RevMan 5.3 software was used to conduct Meta-analysis. Results A total of 12 case-control studies were collected after screening, including 1 380 cases of gastric cancer, with Caveolin-1 expressed positive in 286 cases; 295 cases of non-carcinoma control, with Caveolin-1 expressed positive in 264 cases; 238 cases of precancerous lesions of gastric cancer, with Caveolin-1 expressed positive in 180 cases. Results of Meta-analysis indicated that: as for Caveolin-1 expression, significant differences were found in non-carcinoma vs. gastric cancer [odds ratio (OR)=23.74, 95% confidence interval (CI) (15.19, 37.11), P<0.000 01], precancerous lesions of gastric cancer vs. gastric cancer [OR=6.58, 95%CI (4.52, 9.58), P<0.000 01], and non-carcinoma control vs. precancerous lesions of gastric cancer [OR=2.88, 95%CI (1.58, 5.25), P=0.000 6]. Significant differences were also found between Caveolin-1 expression and gastric cancer clinical pathologic features in undifferentiated vs. differentiated tissue [OR=0.48, 95%CI (0.33, 0.70), P=0.000 1], and without vs. with lymph node metastasis [OR=3.19, 95%CI (1.77, 5.74), P=0.000 1]. Conclusions Caveolin-1 expression is lesser in most gastric cancer patients than in the controls, and is closely associated with its clinical pathologic features. Due to limited quantity and quality of included studies, more high quality studies are needed to verify the conclusion of Caveolin-1 as a tumor marker in gastric cancer.
In combination with the national health informatization construction in UK during the past ten years, this article introduced the resource construction of decision making knowledge library like British Electronic Medicine Library Clinical Pathway Database and NHS Evidence, as well as the function and application of clinical decision support system (CDSS) like PRODIGY, medical knowledge map and so on, discussed the development characteristics and construction experiences of British health decision support system (HDSS). And aiming directly at Chinese specific circumstances, this article offered some suggestions on promoting China HDSS development, for instance, dynamically integrating CDSS with patients’ diagnosis and treatment procedure through the electronic medical record system, strengthening the resources construction of knowledge library, establishing localized clinical pathway, and so on.
ObjectiveTo explore the effect of clinical pathway in peri-operative nursing management of patients with esophageal carcinoma. MethodsA total of 120 patients with esophageal cancer who underwent the operation between January 2010 and April 2012 were divided into control group and trial group. the patients in control group was given conventional esophageal carcinoma peri-operative management; while the ones in the trial group received clinical pathway standardized management. The hospitalization days, costs of hospitalization, complications, satisfaction of the patients and families were compared between the two groups. ResultsThe length of hospitalization days and costs in the trial group were lower than those in the control group (P<0.01); the patients and families satisfaction in the trial group was superior to the control group (P<0.05); the difference in complications occurrence between the two groups was not significant (P>0.05). ConclusionThe clinical pathway of peri-operative nursing management for patients with esophageal cancer could effectively decrease the costs, improve satisfaction of the patients and families, and ensure the quality of care and improve the nursing efficiency.
The two factors that affect enrollment of participants and the process of intervention in randomizedcontrolled pragmatic trials are similar to the situation of clinical practice, thus its effects are similar to the situation ofclinical practice. Therefore, when one estimates an intervention’s effect on a patient, it will be more similar to a real clinicalsituation than results taken from an explanatory trial. Due to the introduction of interventions and process variables usedin a pragmatic trial that conform to traditional Chinese medicine and acupuncture practices, more and more interest isgrowing among researchers in the traditional Chinese medicine field. This article introduces the principles and conceptsof the pragmatic trial, and the key points of design via some samples.