Application of quality control management based on clinical pathway in orthopaedic day surgery_West China Medical Journal

Authors：

NIE Boyuan , WANG Qingling , LI Beilei ,  YANG Zhaohui

Day Surgery Department, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P. R. China;

Corresponding author：

YANG Zhaohui, Email: yangzh101@sina.com

Keywords：

Clinical pathway; Quality control management; Orthopaedic day surgery

DOI：

10.7507/1002-0179.202101031

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the application of clinical pathway in patients undergoing orthopedic day surgery.Methods Patients 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.Results The 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).Conclusion Compared 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.

Citation： NIE Boyuan, WANG Qingling, LI Beilei, YANG Zhaohui. Application of quality control management based on clinical pathway in orthopaedic day surgery. West China Medical Journal, 2021, 36(2): 173-177. doi: 10.7507/1002-0179.202101031 Copy

1.	Philip BK. Day care surgery: the United States model of health care. Ambul Surg, 2012, 17(4): 81-82.
2.	Hoggett L, Anderton MJ, Khatri M. 30-day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centre. Ann R Coll Surg Engl, 2019, 101(1): 50-54.
3.	Cadariu F, Enache A, Avram M, et al. Day surgery in Romania. Ann Ital Chir, 2017, 88: 567-571.
4.	Jarrett PEM. The International Association for Ambulatory Surgery (IAAS). Ambul Surg, 2003, 10(3): 113.
5.	国务院办公厅. 国务院办公厅关于加强三级公立医院绩效考核工作的意见. (2019-01-30)[2021-01-05]. http://www.gov.cn/zhengce/content/2019-01/30/content_5362266.htm.
6.	刘洋, 马洪升, 李志超, 等. 日间腹腔镜胆囊切除术临床路径的 PDCA 管理. 中国病案, 2016, 17(12): 35-37.
7.	张磊, 王小成, 赵晓燕, 等. 四川大学华西医院日间手术临床路径管理基本规范. 华西医学, 2019, 34(2): 150-154.
8.	Mitchell M. Literature review: home recovery following day surgery. Ambulat Surg, 2013, 19(1): 13-27.
9.	Mitchell M. Home recovery following day surgery: a patient perspective. J Clin Nurs, 2015, 24(3/4): 415-427.
10.	张莹, 辛科道, 黄辉, 等. 日间手术存在的问题与发展策略研究. 医学与哲学, 2018, 39(2): 84-87.
11.	杨玲, 黄小龙, 罗旭, 等. 国内外日间手术发展现状与思考. 中国卫生质量管理, 2020, 27(4): 33-37.
12.	Svenson M, Nilson U, Svantesson M. Patients’ experience of mood while waiting for day surgery. J Clin Nurs, 2016, 25(17/18): 2600-2608.
13.	Anderson T, Walls M, Canelo R. Day case surgery guidelines. Surgery (Oxford), 2017, 35(2): 85-91.
14.	陶红兵, 刘鹏珍, 梁婧, 等. 实施临床路径的医院概况及其成因分析. 中国医院管理, 2010, 30(2): 28-30.
15.	赵亮, 张颖, 胡牧, 等. 临床路径实施与应用效果探讨. 中华医院管理杂志, 2010, 26(7): 497-500.
16.	杨炯, 李劲松, 徐卫国. 临床路径评价指标体系的设计与构建. 中国医院管理, 2010, 30(11): 23-25.
17.	陈相军, 宋应寒, 陈敏, 等. 四川大学华西医院日间手术质量和安全管理规范. 华西医学, 2019, 34(2): 155-158.
18.	陈阳, 程雪莲, 何中臣, 等. 《医疗质量管理办法》的亮点与局限. 中国医院管理, 2017, 37(2): 27-29.
19.	Lambooij MS, Drewes HW, Koster F. Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC Med Inform Decis Mak, 2017, 17(1): 17.
20.	章春燕, 桑梓桐, 张新静, 等. 临床路径在新建医院医疗质量管理中的作用. 中国病案, 2019, 20(11): 34-36.
21.	岑朝, 覃灵玲, 禤中平. 以医嘱为核心制定临床路径文本及实施效果分析. 现代医院, 2018, 18(3): 327-330.
22.	缪传文, 李群, 陈德键, 等. 日间手术质量管理与评价探讨. 中国医院管理, 2017, 37(12): 42-43.
23.	Mattila K, Hynynen M; Intensium Consortium Study Group. Day surgery in Finland: a prospective cohort study of 14 day-surgery units. Acta Anaesthesiol Scand, 2009, 53(4): 455-463.
24.	Tolvi M, Tuominen-Salo H, Paavola M, et al. Root causes of extended length of stay and unplanned readmissions after orthopedic surgery and hand surgery: a retrospective observational cohort study. Patient Saf Surg, 2020, 14: 27.
25.	郭晶, 刘素珍, 李继平, 等. 日间手术医院社区一体化协作网的建立及管理. 中华护理杂志, 2013, 48(11): 986-988.

1. Philip BK. Day care surgery: the United States model of health care. Ambul Surg, 2012, 17(4): 81-82.
2. Hoggett L, Anderton MJ, Khatri M. 30-day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centre. Ann R Coll Surg Engl, 2019, 101(1): 50-54.
3. Cadariu F, Enache A, Avram M, et al. Day surgery in Romania. Ann Ital Chir, 2017, 88: 567-571.
4. Jarrett PEM. The International Association for Ambulatory Surgery (IAAS). Ambul Surg, 2003, 10(3): 113.
5. 国务院办公厅. 国务院办公厅关于加强三级公立医院绩效考核工作的意见. (2019-01-30)[2021-01-05]. http://www.gov.cn/zhengce/content/2019-01/30/content_5362266.htm.
6. 刘洋, 马洪升, 李志超, 等. 日间腹腔镜胆囊切除术临床路径的 PDCA 管理. 中国病案, 2016, 17(12): 35-37.
7. 张磊, 王小成, 赵晓燕, 等. 四川大学华西医院日间手术临床路径管理基本规范. 华西医学, 2019, 34(2): 150-154.
8. Mitchell M. Literature review: home recovery following day surgery. Ambulat Surg, 2013, 19(1): 13-27.
9. Mitchell M. Home recovery following day surgery: a patient perspective. J Clin Nurs, 2015, 24(3/4): 415-427.
10. 张莹, 辛科道, 黄辉, 等. 日间手术存在的问题与发展策略研究. 医学与哲学, 2018, 39(2): 84-87.
11. 杨玲, 黄小龙, 罗旭, 等. 国内外日间手术发展现状与思考. 中国卫生质量管理, 2020, 27(4): 33-37.
12. Svenson M, Nilson U, Svantesson M. Patients’ experience of mood while waiting for day surgery. J Clin Nurs, 2016, 25(17/18): 2600-2608.
13. Anderson T, Walls M, Canelo R. Day case surgery guidelines. Surgery (Oxford), 2017, 35(2): 85-91.
14. 陶红兵, 刘鹏珍, 梁婧, 等. 实施临床路径的医院概况及其成因分析. 中国医院管理, 2010, 30(2): 28-30.
15. 赵亮, 张颖, 胡牧, 等. 临床路径实施与应用效果探讨. 中华医院管理杂志, 2010, 26(7): 497-500.
16. 杨炯, 李劲松, 徐卫国. 临床路径评价指标体系的设计与构建. 中国医院管理, 2010, 30(11): 23-25.
17. 陈相军, 宋应寒, 陈敏, 等. 四川大学华西医院日间手术质量和安全管理规范. 华西医学, 2019, 34(2): 155-158.
18. 陈阳, 程雪莲, 何中臣, 等. 《医疗质量管理办法》的亮点与局限. 中国医院管理, 2017, 37(2): 27-29.
19. Lambooij MS, Drewes HW, Koster F. Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC Med Inform Decis Mak, 2017, 17(1): 17.
20. 章春燕, 桑梓桐, 张新静, 等. 临床路径在新建医院医疗质量管理中的作用. 中国病案, 2019, 20(11): 34-36.
21. 岑朝, 覃灵玲, 禤中平. 以医嘱为核心制定临床路径文本及实施效果分析. 现代医院, 2018, 18(3): 327-330.
22. 缪传文, 李群, 陈德键, 等. 日间手术质量管理与评价探讨. 中国医院管理, 2017, 37(12): 42-43.
23. Mattila K, Hynynen M; Intensium Consortium Study Group. Day surgery in Finland: a prospective cohort study of 14 day-surgery units. Acta Anaesthesiol Scand, 2009, 53(4): 455-463.
24. Tolvi M, Tuominen-Salo H, Paavola M, et al. Root causes of extended length of stay and unplanned readmissions after orthopedic surgery and hand surgery: a retrospective observational cohort study. Patient Saf Surg, 2020, 14: 27.
25. 郭晶, 刘素珍, 李继平, 等. 日间手术医院社区一体化协作网的建立及管理. 中华护理杂志, 2013, 48(11): 986-988.

Previous Article
Progress in clinical research related to coronavirus disease 2019
Next Article
Clinical practice of same-day surgery mode of Mammotome minimally invasive operation in ambulatory surgery center

West China Medical Journal

Application of quality control management based on clinical pathway in orthopaedic day surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content