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 explore the effect of lean management on patients’ safety, medical quality, and satisfaction in day surgery ward. Methods The patients underwent day surgery between May 4th, 2017 and April 30th, 2018 were selected as the subjects (the lean management of day surgery ward implemented on November 1st, 2017). The patients underwent day surgery between May 4th and October 31st, 2017 were taken as the control group (n=2 864), and the ones between November 1st, 2017 to April 30th, 2018 were taken as the observation group (n=2 705). The following data between the two groups were compared: the cancellation rate of day surgery, the 24-hour delayed discharge rate, the rate of 12-hour median or severe pain after surgery, the rate of 12-hour postoperative nausea and vomiting, the awareness rate of health education, the patients’ satisfaction, and the incidence of adverse events.Results Compared with those in the control group, the cancellation rate of surgery (4.81% vs. 6.25%), the 24-hour delayed discharge rate (2.76% vs. 4.28%), the 12-hour median or severe pain after surgery (5.55% vs. 8.31%), the rate of 12-hour postoperative nausea and vomiting (5.86% vs. 7.71%) decreased in the observation group, and the differences were statistically significant (P<0.05). The awareness rate of health education increased from 92.18% to 98.02% after the implementation of lean management, the patients’ satisfaction increased from 92.48±2.58 to 96.53±1.64 after the implementation of lean management, and the differences were statistically significant (P<0.05). The incidences of adverse events in the two groups were not statistically different (0.16% vs. 0.41%, P>0.05). Conclusion The implementation of lean management model can insure the medical safety and quality of day surgery, and improve overall work efficiency and the patients’ medical service experience in day surgery ward.
Since 2015, when the day surgery mode was officially reckoned and supported by the National Health Commission, the day surgery model has entered the new period of rapid development. But at the same time, challenges in the vacancy of the evaluation indexes of the medical quality and safety of day surgery still pose obstacles to its growth. At present, there is no nationally unified evaluating index or appraising system for the day surgery-related medical quality and safety. In this paper, based on structure-process-outcome theory, the day surgery practice and involved researching literature were retrieved, reviewed, and analyzed. Also, the practice model at West China Hospital of Sichuan University (a pioneer day surgery hospital in China) was comprehensively compared with the National Clinical Improvement System. From the aspect of day surgery medical quality and safety evaluation indicators, it is hoped to provide an evidence-based method and evaluation of day surgery, and a theoretical basis for establishing policies and data reference.
Day surgery is one of the key tasks of the national medical reform. It is still in the stage of rapid developing in the country. It is the responsibility of the large general hospitals to explore the effective management mode of the day surgery center to meet the clinical quality and safety. During the establishment and management of day surgery center in general hospital, it is needed to build a strong specialized day surgery team through professional training, and to establish a coordination and incentive mechanism for the cooperation between the day ward and the specialized subjects by introducing lean thinking strategy. According to the characteristics of day surgery, the clinical pathway management and the whole course rehabilitation and the health education system of day surgery are established. The formulate norms for medical records of day surgery will be built. The monitoring system for the efficiency and safety of day surgery is established to improve the medical quality and safety of day surgery. As a result, the model of day surgery that conforms to the medical characteristics of China will be established.
Venous thromboembolism (VTE) is a high-risk complication in hospitalized patients, especially in patients with orthopedic surgery, neurosurgery, thoracic surgery, cardiac surgery and tumor surgery. It is also a significant cause of patients’ unexpected death and perioperative death. Through establishment of norms of VTE management system and organizational structure, formulation of perfect VTE risk assessment system and prevention and treatment scheme for hospitalized patients, training of all the medical staff for related knowledge, and test operation of the system in key departments, we established a hospital standardized system of venous thromboembolism prevention and management. Our VTE prevention and treatment work achieved good results through multidisciplinary collaboration.
摘要:医院有效事前监测、管控医疗不良事件，是保障患者安全、提高医疗质量的管理措施之一。超大型医院对医疗不良事件管理的实战中，建立、实施医疗安全隐患事件关键监测指标、医疗安全隐患事件筛查程序指标，积极开展医疗不良事件后台监管工作，切断医疗安全隐患事件向医疗风险事件演变、医疗风险事件向医疗纠纷事件演变的环节，保障患者安全。Abstract: Effective supervision in advance to the medical adverse event, is one of measures which hospital adopt to guarantee patient safety and enhance medical quality. The actual combat of supervision to the medical adverse event in super sized hospital, set up and put in practice on the key target of supervising the medical adverse event and the key target of ridding procedure, remain in the background and work actively on supervision on the medical adverse event, shut off the road from the medical safety issue to the medical risk issue and the road from the medical risk issue to the medical dissension in order to guarantee the patient safety.