The anesthetic work of day surgery should be guided by the standardized perioperative evaluation system. The evaluation methods and standards with strong operability and repeatability are the prerequisites to ensure the safety and efficiency of day surgery. For the assessment of patients’ preoperative physiological status, preoperative preparation and postoperative rehabilitation, standardized work procedures should be established to ensure patients’ medical safety to the greatest extent. Through summarizing the advanced management experience of day surgery anesthesia at home and abroad, and combining with the principled suggestions in The Consensus of Chinese Experts on Anaesthesia for Day Surgery, the First Affiliated Hospital of Dalian Medical University has repeatedly revised the perioperative anesthesia evaluation methods in practice, and gradually explored a comprehensive, rigorous and standardized perioperative anesthesia evaluation system. This paper will focus on the evaluation of perioperative anesthesia and postoperative follow-up procedures in day surgery.
Objective
To explore the effect of the feed-forward control on safety nursing of ophthalmologic day surgery patients under general anesthesia.
Methods
A total of 623 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the control group, who adapted the routine nursing in the Ophthalmic Day Surgery Center from January to December 2015; a total of 1 210 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the observation group, who received the feed-forward control of nursing safety management on the basis of routine nursing care from January to December 2016. The incidence rate of the adverse events and potential safety hazards and satisfaction rate were compared between the two groups.
Results
The incidence rate of the adverse events and potential safety hazards in the observation group (0.83%, 10/1 210) was lower than that in the control group (3.37%, 21/623), the satisfaction rate in the observation group (98.67%) was higher than that in the control group (97.11%), and the differences were statistically significant (P<0.05).
Conclusion
The application of feed-forward control in the safety care of patients during the ophthalmologic day surgery under general anesthesia can effectively reduce the incidence of adverse events and potential safety hazards, and ensure the safety of medical care.
ObjectiveTo establish a sound management system for day surgery under the Joint Commission International (JCI) standard.MethodsFrom 2013, according to the provisions of JCI standard, a sound management system was established in the Second Affiliated Hospital of Zhejiang University School of Medicine by establishing the organizational structure of day surgery management, standardizing the operation process of day surgery, formulating standard operating rules and regulations, clarifying work responsibilities, strengthening the supervision of medical quality indicators at both hospital and department levels, and providing guidance for continuous performance.ResultsThe number of day operations in the hospital increased gradually, accounting for 25% of elective operations. During this period, there was no death of the patient, and these indexes remained low: the reservation cancellation rate of the patient was 0.9%, the transfer hospitalization rate was 0.23%, the unplanned reoperation rate was 0.012%, and the postoperative serious complications (bleeding, wound opening, etc.) was 0.03%.ConclusionThe establishment of day surgery management system under the JCI standard can standardize the development of day surgery and ensure the safety of patients.
Day surgery is flourishing in public hospitals in China with the advantages of strong planning, short stay and high efficiency. Under the background of “diversification of surgeons, diversification of disease structure and precision of scheduling needs”, higher requirements are put forward for refined scheduling strategies of day surgery. The research of scientific and precise surgical scheduling strategy is of great significance to realize efficient coordination and optimal allocation of day surgical resources. This article reviews the necessity of precise scheduling of day surgery, the current situation of scheduling of day surgery, the key dimensions affecting the scheduling of day surgery, and the evaluation system for precise scheduling of day surgery.
Objective To analyze the causes of day surgery patients missing appointments, and discuss the countermeasures. Methods We selected the patients who had missed appointments for day surgery in the Second Affiliated Hospital Zhejiang University School of Medicine between January 2017 and June 2022. According to the implementation time of the measures, we divided the patients into two groups: pre-intervention (between January 2017 and June 2020) and post-intervention (between July 2020 and June 2022), to analyze the causes of patients’ cancellation, compare the change of patients’ cancellation rate before and after the implementation of measures, and explore the effectiveness of implementation measures. Results A total of 17 392 patients were included, and the total number of day surgery patients was 148 720 during the same period. The total cancellation rate was 11.69% (17 392/148 720). The cancellation rate in the post-intervention was lower than that in the pre-intervention [9.70% (7 935/81 775) vs. 14.13% (9 457/66 945), odds ratio was 0.695, 95% confidence interval (0.674, 0.717), P<0.001]. There were 13 common reasons for cancellation, of which “outpatient treatment, not hospitalization” was the most common reason. Conclusion Through the coordination of various departments, actively optimizing the preoperative evaluation of patients, updating the appointment process, strengthening effective communication and implementing the implementation of efficient medical treatment, the cancellation rate of day surgery can be reduced, which has certain reference significance to improving the management level of the hospital and the ability to serve patients.
ObjectiveTo investigate the preoperative cognition of the patients undergoing daytime ophthalmic fundus surgery and understand their needs of health education, so as to provide an evidence for efficient and accurate preoperative health education services within the limited time of the ophthalmic day fundus surgery.MethodsThe convenient sampling method was used to select the patients who met the inclusion criteria in the ambulatory operating room of Beijing Tongren Hospital, Capital Medical University from December 2017 to May 2018. The study included three parts: the general information of the patients, the preoperative cognition of the patients, and the needs for health education service of the patients. Questionnaires were designed according to the research purpose and method, which were distributed and recovered by professionals.ResultsA total of 112 patients were included. Among them, the cognitive scores of operation process (2.57±0.56), preoperative diet (2.58±0.59), preoperative medication (2.60±0.64), and psychological status (2.58±0.65) were relatively low. More health education services were needed in three aspects: the cognition of operation details [operation duration (85.71%), surgeons (79.46%), operation start time (76.79%)], intraoperative cooperation (90.18%), and intervention for preoperative anxiety (78.57%).ConclusionNurses should formulate the contents of preoperative health education according to the preoperative cognition and nursing needs of patients, so as to provide efficient and accurate health education services for patients.
Day surgery mode is a challenge for surgeons, anesthesiologists, nurses, and managers. Standardized management should be implemented in each management model, no matter centralized management or decentralized management model, by utilizing the theory of enhanced recovery after surgery and information management to establish a system to ensure patient’s safety and medical quality. Only in this way the development of day surgery will be healthy and sustainable.
ObjectiveTo investigate the effect of quality control circle (QCC) activity in reducing the temporarily stopping rate of day surgery.MethodsThe QCC activity was carried out from December 2018 to October 2019. By determining the theme of the activity and drawing up the plan, a retrospective analysis of pre-hospital day surgery stoppage status and reasons was performed based on 2 696 patients who had reserved surgery in the day surgery center from December 2018 to February 2019. Based on the data, the goal was determined, and measures were developed and confirmed from May to August 2019. Then the measures were standardized and implemented continuously from September to October 2019. The rate of surgical cessation before the implementation of the measures (from December 2018 to February 2019) was compared with that after the implementation of the measures (from September to October 2019).ResultsAfter the QCC activity, the temporarily stopping rate decreased from 2.89% to 1.34%, and the difference was statistically significant (P<0.001).ConclusionThe QCC activity can effectively reduce the temporarily stopping rate of day surgery, and lay the foundation for continuously promoting the optimization of day surgery resources and quality improvement.
Day surgery dates back to 1909, when it was first performed by British paediatricians. Anesthesia management for day surgery requires quick onset, early recovery, rapid recovery, and few perioperative adverse reactions. Ensuring the medical safety of patients is the primary condition for the gradual implementation of day surgery. With the continuous development of medical level, the applicable field of day surgery has gradually expanded, and new concepts and progress have also emerged in anesthesia management. This article summarizes the relevant research at home and abroad, and reviews the new progress of anesthesia for day surgery from three aspects: preparation before anesthesia, selection of anesthesia methods, and recovery after anesthesia, in order to provide a reference for anesthesia management of day surgery.
Day surgery is regarded as a breakthrough in promoting the construction of hierarchical diagnosis and treatment because of its advantages such as effectively shortening the length of hospital stay and making full use of medical resources. In order to comply with the national policies, medical development, patient needs, and other factors, as a comprehensive tertiary hospital, Zhengzhou Central Hospital Affiliated to Zhengzhou University taking regional synergy as a carrier, combining with 92 medical units, actively explores the rational flow of patients with day surgery in the region, through implementing clinical path management, controlling surgery expenses and drug and consumables proportions, purchasing medical health insurance for day surgery patients to ensure patient safety, opening a green channel for patients at the grassroots level, effectively using the medical insurance to co-ordinate funds, and rationally planning medical treatment procedures, ect.
