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：

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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.	國務院辦公廳. 國務院辦公廳關于加強三級公立醫院績效考核工作的意見. (2019-01-30)[2021-01-05]. http://www.gov.cn/zhengce/content/2019-01/30/content_5362266.htm.
6.	劉洋, 馬洪升, 李志超, 等. 日間腹腔鏡膽囊切除術臨床路徑的 PDCA 管理. 中國病案, 2016, 17(12): 35-37.
7.	張磊, 王小成, 趙曉燕, 等. 四川大學華西醫院日間手術臨床路徑管理基本規范. 華西醫學, 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.	張瑩, 辛科道, 黃輝, 等. 日間手術存在的問題與發展策略研究. 醫學與哲學, 2018, 39(2): 84-87.
11.	楊玲, 黃小龍, 羅旭, 等. 國內外日間手術發展現狀與思考. 中國衛生質量管理, 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.	陶紅兵, 劉鵬珍, 梁婧, 等. 實施臨床路徑的醫院概況及其成因分析. 中國醫院管理, 2010, 30(2): 28-30.
15.	趙亮, 張穎, 胡牧, 等. 臨床路徑實施與應用效果探討. 中華醫院管理雜志, 2010, 26(7): 497-500.
16.	楊炯, 李勁松, 徐衛國. 臨床路徑評價指標體系的設計與構建. 中國醫院管理, 2010, 30(11): 23-25.
17.	陳相軍, 宋應寒, 陳敏, 等. 四川大學華西醫院日間手術質量和安全管理規范. 華西醫學, 2019, 34(2): 155-158.
18.	陳陽, 程雪蓮, 何中臣, 等. 《醫療質量管理辦法》的亮點與局限. 中國醫院管理, 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, 張新靜, 等. 臨床路徑在新建醫院醫療質量管理中的作用. 中國病案, 2019, 20(11): 34-36.
21.	岑朝, 覃靈玲, 禤中平. 以醫囑為核心制定臨床路徑文本及實施效果分析. 現代醫院, 2018, 18(3): 327-330.
22.	繆傳文, 李群, 陳德鍵, 等. 日間手術質量管理與評價探討. 中國醫院管理, 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, 劉素珍, 李繼平, 等. 日間手術醫院社區一體化協作網的建立及管理. 中華護理雜志, 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. 國務院辦公廳. 國務院辦公廳關于加強三級公立醫院績效考核工作的意見. (2019-01-30)[2021-01-05]. http://www.gov.cn/zhengce/content/2019-01/30/content_5362266.htm.
6. 劉洋, 馬洪升, 李志超, 等. 日間腹腔鏡膽囊切除術臨床路徑的 PDCA 管理. 中國病案, 2016, 17(12): 35-37.
7. 張磊, 王小成, 趙曉燕, 等. 四川大學華西醫院日間手術臨床路徑管理基本規范. 華西醫學, 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. 張瑩, 辛科道, 黃輝, 等. 日間手術存在的問題與發展策略研究. 醫學與哲學, 2018, 39(2): 84-87.
11. 楊玲, 黃小龍, 羅旭, 等. 國內外日間手術發展現狀與思考. 中國衛生質量管理, 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. 陶紅兵, 劉鵬珍, 梁婧, 等. 實施臨床路徑的醫院概況及其成因分析. 中國醫院管理, 2010, 30(2): 28-30.
15. 趙亮, 張穎, 胡牧, 等. 臨床路徑實施與應用效果探討. 中華醫院管理雜志, 2010, 26(7): 497-500.
16. 楊炯, 李勁松, 徐衛國. 臨床路徑評價指標體系的設計與構建. 中國醫院管理, 2010, 30(11): 23-25.
17. 陳相軍, 宋應寒, 陳敏, 等. 四川大學華西醫院日間手術質量和安全管理規范. 華西醫學, 2019, 34(2): 155-158.
18. 陳陽, 程雪蓮, 何中臣, 等. 《醫療質量管理辦法》的亮點與局限. 中國醫院管理, 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, 張新靜, 等. 臨床路徑在新建醫院醫療質量管理中的作用. 中國病案, 2019, 20(11): 34-36.
21. 岑朝, 覃靈玲, 禤中平. 以醫囑為核心制定臨床路徑文本及實施效果分析. 現代醫院, 2018, 18(3): 327-330.
22. 繆傳文, 李群, 陳德鍵, 等. 日間手術質量管理與評價探討. 中國醫院管理, 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, 劉素珍, 李繼平, 等. 日間手術醫院社區一體化協作網的建立及管理. 中華護理雜志, 2013, 48(11): 986-988.

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

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