This article introduced the structure and features of the medical safety and quality management system of New South Wales (NSW) of Australia. The system was funded by government with overall design, multi-sectors involvement, and explicit roles of government, hospitals, and independent third parties. The system also developed national and state-wide regulations, policies, standards and their certification. The NSW Health Incident Information Management System (IIMS), the guidelines and interventional programs were also established to decrease the medical risk and ensure the healthcare quality. This system will be used for reference to the national medical risk and quality management system of China.
Objective To enhance medical quality evaluation by conducting a systematic review and evidence-based synthesis of relevant research. Methods Such databases as CBM (1978 to 2009), VIP (1989 to 2009), CNKI (1990 to 2009), WanFang Dissertation database (1997 to 2009), and relevant websites were searched to identify relevant Chinese studies for the synthetical evaluation on methods evaluating medical quality. Results A total of 216 articles including 184 observational studies, 29 traditional reviews, and 3 experts’ opinions were identified. Twenty-one synthetical evaluation methods were used among 216 articles, and the top three methods which had been quoted more than 30 times were: RSR (19.72%), TOPSIS method (19.03%), and comprehensive index (12.80%). Among the 184 observational research papers, the documents using one kind of comprehensive evaluation took up 89.13% (164/184), the ones using two kinds of evaluation methods accounted for 9.78% (18/184), and those using three kinds of methods accounted for 1.09% (2/184). Conclusion a) The joint use of two or more than two methods is not common. The majority of studies using single comprehensive evaluation method focus on RSR, TOPSIS and comprehensive index method; b) The comprehensive evaluation method is considered non-uniform, some not even standardized; c) Most of the medical literatures do not correct the value of quality assessment; and d) Considerably most studies perform retrospective evaluation with historical data.
Objective To explore the feasibility and the security of one-day stay ward in stripping surgery of saphenous vein varicosity. Methods Two hundred and eighty two patients treated in our hospital in 2011 were enrolled in this study， according to the operation mode， these patients were divided into 2 groups， ninety patients in one-day stay ward group and one hundred and ninety two patients in in-patient group. Their clinical features and medical operation indexs（included preoperative waiting time， duration of hospital stay， and medical cost）were retrospectively analyzed. Results There was no statistical differences on clinical features between the two groups. But compared with in-patient group， the preoperative waiting time， duration of hospital stay， and medical cost were shorter or lower in one-day stay ward group （P＜0.05）. Conclusions The one-day stay ward operation mode can decrease preoperative waiting time， duration of hospital stay and medical cost significantly， and it also can ensure the safety of clinical treatment. So it’s worthy in the clinical promotion.
ObjectiveTo assess the efficacy and safety of pediatric day surgery (PDS) program. MethodsWe retrospectively analyzed 148 pediatric surgeries between June 2012 and June 2013, including 31 for cryptorchidism, 53 for concealed penis, and 64 for hernia. According to the operation mode, these children were divided into PDS group and in-patient group. Analysis of the postoperative complications and hospital stay, and hospitalization expenses was carried out. ResultsThere was no statistical differences on success rate of operation, re-admission rate, postoperative fever, and postoperation nausea and vomiting between the two groups (P>0.05). But compared with the in-patient group, hospitalization expenses, medical cost, therapeutic treatment fee and hospital stay were significantly lower or shorter in the PDS group (P<0.05). ConclusionPDS is a safe and cost-effective program that reduces the average hospitalization days, reduces the per capita hospitalization cost, increases the turnover of beds, and benefits the child and the family.
ObjectiveTo explore the application of PDCA cycle in the examination of medical quality of Tibetan area hospitals. MethodsIn the October 2014, PDCA cycle theory was introduced into the examination of Tibetan hospital medical quality. We collected quality problems existing in the medical activities actively, analyzed the reason and influencing factors and made corresponding plans. Then we implemented the plans and measures strictly, surveyed the results, found out and analyzed the problems, summarized the results of the examination, and turned the unsolved problems to the next PDCA circulation. Continuous follow-up was performed until the results were satisfactory. Based on Sichuan Province Secondary Comprehensive Hospital Evaluation Standard, we analyzed the medical quality of the hospital before PDCA application (July to September 2014) and after PDCA application (October to December 2014). ResultsThe incidence of medical nursing documents writing defects decreased from 12.4% to 5.9%. Hospital infection management defect rate declined from 13.5% to 5.3% and drug safety management defect rate declined from 11.8% to 2.5%, and all the differences were statistically significant (P<0.05). ConclusionPDCA cycle in the Tibetan hospital for medical quality examination has greatly improved the medical quality of Tibetan hospitals.
Hospital trusteeship means that the property owners of the hospital, through the form of contract and for the purpose of value preservation and proliferation, authorize a corporation or human being with strong administrative management capabilities and risk-bearing abilities to manage the hospital. With the deepening medical reform, the model has been gradually widely used. In this context, a well-known public hospital became the trustee of a newly established comprehensive private hospital. Taking the greatest advantage of its medical quality management, the trustee used SWOT (strengths, weaknesses, opportunities, and threats) analysis to develop efficient decision-making mechanism, strengthened the process optimization transformation, and improved the innovative means of information technology for the development of the new hospital, which has achieved very good results.
ObjectiveTo evaluate the safety and quality of patients in day surgery. MethodsThe clinical data of patients in day surgery from March to December 2014 in this hospital were collected. The incidence of complications, delayed discharge rate, rate of readmission to hospital, satisfaction, and so on, were analyzed. ResultsOf 5 520 patients were in day surgery, including laporoscopic cholecystectomy, hernia repair surgery, vocal cord polyps resection, breast minimally invasive surgery, varicose vein of lower limb, choledochoscopy, gastrointestinal polyposis, and so on. No patient was loss of follow-up, unplanned reoperation or death after day surgery. There were 39.95%(2 205/5 520) of wound pain and 0.51%(28/5 520) of postoperative nausea and vomiting in the complications. The delayed discharge rate was 0.62%(34/5 520), the rate of unplanned readmission to hospital was 0.49%(27/5 520), and the satisfaction rate was 98.99%(5 464/5 520). ConclusionFor the above surgery types in this study, the day surgery mode is safe and effective.
ObjectiveTo analysis the reasons of delayed discharge in day surgery ward, so as to provide the basis for discharged quality monitoring of ambulatory surgery management. MethodsA retrospective survey was conducted on patients admitted in Department of Day Surgery Center of West China Hospital of Sichuan University from April 2012 to August 2014 after day surgery. The characteristics of patients classified as "delayed discharge patients" were described and the factors associated with delayed discharges were analyzed by using SPSS 19.0 software. ResultsA total of 14 560 patients were included, of which 81 patients were classified as "delayed discharge", and the rate of delayed discharge was 0.56% (81/14 560). Single disease delayed discharge rates were as follows: gallstone 2.13% (37/1 737), operation for varicose veins of lower limbs 1.91% (11/576), gastrointestinal polyps resection 0.33% (11/3 325), inguinal herniorrhaphy 0.63% (9/1 424), polyp of vocal cord resection 0.21% (4/1 879), breast package block minimally invasive resection 0.11% (2/1 761), choledochoscopy 0.06% (1/1 563) and other surgical 0.26% (6/2 295). No significant differences were found between the delayed discharge patients and normal discharge patients in age and gender (P>0.05). Compared with the normal discharge patients, there were significant differences in the four aspects of operation mode changes, postoperative complications, anesthesia factors and patient's own factors of delayed discharge patients (P<0.05). ConclusionThe changes of operation mode, postoperative complications, anesthesia factors and patient's own factors are related to the delay of hospital discharge. Strictly grasping the indications for ambulatory surgery and anesthesia patients, strengthening the admission education, letting the patients accept day surgery fully in psychological and preventing the possible complications and ensure the quality and safety after day surgery.