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.
Under the background of promoting day surgery nationwide and ensure the medical quality, fine management is crucial and in trend. As one of the earliest central health organizations that started day surgery service in China, West China Hospital of Sichuan University has conducted approximate 140 000 day surgery cases in the past nearly 10 years. Based on the experience of practice, West China Hospital of Sichuan University has summarized 26 clinical indicators from 5 aspects to evaluate and monitor the economic efficacy and medical quality and safety of day surgery, including the input and output, the efficiency, the patient experience, the medical quality and safety, and the difficulty evaluation of surgery. The aim is to explore and establish an appraisal and monitoring system for day surgery, promote the stable development of day surgery, improve the work efficiency, and take the government plan of implementation day surgery to improve medical services into action.
In 2022, the General Office of the National Health Commission issued Interim Regulations on Quality Management of Day Care in Medical Institutions, which strictly regulated the requirements for medical institutions to carry out day surgery, reflecting that medical quality and safety management is the core principle of day surgery management. Medical quality and safety management is the core foundation of the sustainable development of day surgery, which directly determines the life cycle and continuous vitality of day surgery in the future development of our country. The remarkable achievements of day surgery at West China Hospital of Sichuan University are attributed to a set of scientific and standardized quality and safety management measures based on clinical pathways. These measures not only provide fine management for every link in the surgical process, but also effectively guarantee the medical safety and treatment effect of patients by optimizing the operation norms before, during and after the operation. This article shares the quality and safety management concept of West China Hospital of Sichuan University, which is “proficient in pre-hospital care, cautious in hospital care, skilled in post-hospital care”, for the peers to learn from and share.
Under the background of promoting the high-quality development of public hospitals, day surgery in China has also entered a stage of refined and high-quality continuous development. The high-quality connotation of day surgery includes high quality of medical treatment, high quality of nursing, high quality of management and high quality of service, which is also a difficulty and challenge faced by current medical management. Among them, medical treatment is the core, nursing and service are the key, and management is the essence of day surgery.
After nearly 30 years of localized development of day surgery in China, in order to enable more patients to enjoy high-quality and affordable day surgery medical services, some medical institutions have begun to try same-day surgery, which means the patient can be operated and discharged within the same workday. With the help of the national three-level diagnosis and treatment service model, it provides continuous medical services and guarantees for day surgery patients through the integration of “hospital-community”. This article first introduces the development history of day surgery, summarizes the definitions and requirements of day surgery in different countries or academic associations, and finally focuses on same-day surgery in China, aims to provide some ideas for the future development of day surgery in China.
Day surgery has been developed in China for over 30 years. However, the admission decisions for day surgery patients are still mainly based on expert experience, brainstorming, and institutional recommendation, and lack scientific admission criteria and universality. West China Hospital of Sichuan University has implemented methods such as semi-supervised learning based on heterogeneous data, to construct a more objective and accurate patient admission model based on large amounts of diagnosis and treatment data. This initiative aims to assist the country and hospital in reducing medical costs and alleviating the acute problem of the current contradiction between supply and demand of medical resources. It also seeks to optimize the utilization and allocation of bed resources, reduce the cost of patient management, enhance the theoretical research on patient admission methods in day surgery in China, and provide reference and inspiration for other hospitals in the day surgery industry in China.
By learning the nearly ten years’ experience and summaries in day surgery, West China Hospital of Sichuan University drafts a series of standards for day surgery management. This article mainly introduces the pre-administration management standards of West China Hospital of Sichuan University, involving: standards for the management of surgeons, nurses, patients, and the type of operation; standards for pre-administration work procedure; standards for pre-administration health education; standards for appointment, scheduling, and coordination for day surgery; and standards for surgery notification. This paper aims to share experience with peer professionals, and provide theoretical basis and practical guidance for the standardization and development of day surgery, as well as the establishment of a safe day surgery management system.
The Day Surgery Center of West China Tianfu Hospital of Sichuan University began operation in 2022, with a focus on same-day surgery. To ensure the quality of medical care for patients undergoing same-day surgery, the Day Surgery Center of West China Tianfu Hospital of Sichuan University utilizes information technology support and adopts an innovative patient health education model. This article mainly introduces the whole process management of health education for patients undergoing same-day surgery mentioned above, which involves many links before admission, during hospitalization, and after discharge. The aim is to provide reference for further optimization of same-day surgery and improve the quality and effectiveness of health education for patients undergoing same-day surgery.
Objective
To discuss the running effect of the modified hospital-community integrated two-way-referral service mode in day surgery.
Methods
The hospital-community integrated two-way-referral service mode in day surgery was built in May 2014 by our center, and applied in the communities’ health service network in Chenghua District, Wuhou District, and Jinjiang District. From March 2017 some improvements of the mode were made, such as assigning specific person for the management of two-way-referral, conducting lectures in communities to train the community medical staff, and carrying out gratuitous treatment. The community acceptance rate and patients satisfaction were retrospectively analyzed between March of 2016 and March of 2017, and the number of upward referral (from community to hospital) was retrospectively analyzed between March to June of 2016 and March to June of 2017.
Results
The community acceptance rate was elevated from 81.3% to 99.1% and the patients satisfaction was improved from 95.4% to 100.0%, and the differences between the two periods were statistically significant (P<0.05). The number of upward referral increased from 0 to 23.
Conclusions
The modified hospital-community integrated service mode could optimize the course of surgery appointment, and make it convenient for patients. Furthermore, it also adjusts the reasonable allocation of medical resource effectively and promotes the implementation of national hierarchical medical system.
