Pictured: Patients in the day surgery ward of West China Hospital are undergoing admission procedures.
Pictured: Nurses at day surgery centers introduce precautions to patients. Photo by Wang Mingfeng
Pictured: Medical staff of the Day Surgery Center of Beijing Tongren Hospital demonstrate the operation of the day surgery appointment system. Photo by Yang Yanfan
On the afternoon of April 8, at the Beijing Tongren Hospital affiliated to Capital Medical University, a 6-year-old nono child underwent day surgery for adenoidal hypertrophy removal. Postoperative observation was normal, and Nono was discharged from hospital on the morning of 9 April, with a hospital stay of no more than 24 hours. "It is particularly convenient to make an appointment in advance for various preoperative examinations and surgery times, and there is no need to wait for a bed in the hospital." Nono's father told reporters.
Day surgery refers to the surgery or operation (excluding outpatient surgery) that the patient enters and exits within one day (24 hours) according to the diagnosis and treatment plan, and the hospitalization period does not exceed 48 hours due to the need to postpone hospitalization due to illness. Day surgery is often compared to the "short and fast" of playing volleyball, and is welcomed by hospitals and patients because of its short time, high efficiency, fast bed turnover, and low cost to patients.
In 2021, the General Office of the State Council issued the "Opinions on Promoting the High-quality Development of Public Hospitals", proposing to vigorously promote day surgery and increase the proportion of day surgery in elective surgery. The "Action to Promote the High-quality Development of Public Hospitals (2021-2025)" issued by the National Health Commission also proposes to establish and improve day medical services.
What are the benefits of day surgery for patients? What are the challenges for hospitals? The reporter conducted an interview on this.
Greatly shorten the waiting and hospitalization time of patients and reduce the economic burden
At The West China Hospital of Sichuan University, patient Ms. Li made an appointment for day surgery for breast cancer on April 7. "I thought I was going to have major surgery and I would have to be hospitalized for a long time. I heard that day surgery was possible, but I was a little worried at first. Ms. Li said that the preoperative doctor's communication was very meticulous, so that she had a thorough understanding of the surgical plan, and her psychological burden was also reduced a lot.
Ms. Li told reporters that the preparation process of day surgery is very convenient: after the outpatient treatment, make an appointment for the operation time on the mobile phone APP, wait for the doctor to prescribe all the preoperative examination items, and complete the examination in turn; two days in advance, the hospital reminds to do nucleic acid within 48 hours; the day before the operation, the daytime surgery center calls again to confirm whether there is a cold or other situation.
"The home environment is better, which is conducive to postoperative recovery, and day surgery is more convenient for family members, eliminating the trouble of running back and forth to the hospital." Ms. Lee's husband said.
In March 2012, the former Health Development Research Center of the National Health and Family Planning Commission took the lead in organizing the Development Center of Shanghai Shenkang Hospital, West China Hospital of Sichuan University, Beijing Tongren Hospital and other units to establish the China Day Surgery Cooperation Alliance. According to the "China Day Surgery Development Report 2020", from 2013 to 2018, the number of medical institutions carrying out day surgery across the country increased by 10.58 times, and the number of day surgery cases increased by 5.86 times.
"In the past, many patients had the idea of being hospitalized before surgery. After hospitalization, various examinations are done first, and then surgery is arranged after the results are released, which is longer in the hospital. Yu Lihua, vice chairman and secretary general of the China Day Surgery Cooperation Alliance and deputy director of the Pharmaceutical Cost and Price Research Department of the Health Development Research Center of the National Health Commission, said that day surgery has completed preoperative examination and evaluation in outpatient clinics through process optimization, effectively reducing the length of hospital stay.
After day surgery, patients' waiting time for beds was significantly reduced. Ni Ruxuan, director of the medical department of Beijing Tongren Hospital, said that in the past, patients awaiting surgery in the hospital's rhinology department had to wait an average of more than 3 months before they could be admitted from the time of issuing their hospitalization permits. Now, from the beginning of the preoperative examination, the operation can be completed in basically one week to two weeks.
Early admission and discharge on the same night after surgery is an ideal day surgery model. "However, some diseases are more special, such as the vast majority of rhinology is general anesthesia surgery, and the nasal cavity must be tamponed to stop bleeding after surgery, and it is necessary to stay overnight to determine that there is no active bleeding before leaving the hospital." Therefore, it is more suitable for afternoon surgery, after one night of observation in the hospital, and then discharged before noon the next day, the time is also within 24 hours. Ni Ruxuan said.
Shortening the length of hospital stay for patients and reducing medical costs are the advantages of day surgery. Ma Hongsheng, director of the Day Surgery Center of West China Hospital of Sichuan University, said that according to preliminary statistics, compared with non-day surgery, the average medical cost of patients has dropped by about 20%. For example, patients with laparoscopic cholecystectomy save an average of about 22 percent. In addition, day surgery also reduces the indirect burden of patients, such as transportation costs for family members to and from work, and lost work expenses.
Yu Lihua said that at present, many provinces across the country have introduced day surgery medical insurance payment policies, whether it is paid by disease type, or DRG (disease diagnosis related grouping), DIP (disease based on big data) payment, day surgery has been included in the payment system. In the future, the reform of medical insurance payment methods will continue to deepen, which will release more demand for day surgery.
Surgical procedures have been further standardized and standardized, and medical quality and safety protection measures have become increasingly complete
What diseases can be included in the scope of day surgery, and how to ensure the safety of patient medical care? This is the most important concern for the public to carry out day surgery.
A few days ago, the National Health Commission issued the "Recommended Catalogue of Day Surgery (2022 Edition)", on the basis of the 43 day surgery procedures recommended in 2016 and the 77 day surgery procedures recommended in 2019, the third batch of day surgery recommended surgery procedures, a total of 708 day surgery operation items, so that the day surgery procedures are further standardized and standardized.
Industry insiders said that hospitals generally choose diseases or surgical methods with mature medical technology, relatively low surgical risk, and few postoperative complications. Ma Hongsheng told reporters that the department technology that each hospital is good at is different, and will choose the surgical type according to its own medical level. Since 2009, West China Hospital has performed more than 300 day surgeries. With the accumulation of experience, more diseases will also enter the category of day surgery.
Ensuring the quality and safety of medical care is a prerequisite for day surgery. Generally speaking, hospitals that perform day surgery have established relevant quality and safety management and guarantee systems. For example, the Day Surgery Quality Management Committee of Beijing Tongren Hospital has made clear provisions on the access standards for diseases, doctors and patients. Hospitals require experienced senior physicians to perform day surgeries, who not only need to have qualifications for surgery or related operations, but also strong doctor-patient communication skills. The criteria for admission are equally important, with patients being monitored for an hour and a half in the recovery room after leaving the operating room, and some patients returning to the ward for monitoring.
"We have established an emergency plan to assess and deal with it in a timely manner if there is a sudden change in the condition. Medical staff will call the patient back to find out how he recovered. Special service telephones are also set up to provide 24-hour emergency consultation services for discharged patients to ensure medical safety. Li Ming, director of the Day Surgery Center of Beijing Tongren Hospital, said.
"The hospital conducts day surgery to serve patients efficiently and safely." Yu Lihua said that day surgery involves multidisciplinary collaboration such as clinical, anesthesia, nursing, rehabilitation, etc., and is a platform that serves all operating departments in the hospital. For some specialty majors, if the patient does not have the conditions to go home after surgery to remove stitches and review, day surgery is not suitable. The hospital should provide a humanized treatment plan according to the actual situation of the patient.
Promote the improvement of the quality of medical services and make the use of medical resources more efficient
With limited bed resources, the benefits of day surgery can effectively improve the efficiency of hospital operations and meet the needs of more patients, and the benefits are obvious. However, the time of day surgery in the hospital has been shortened, and the links such as outpatient visits, bed appointments, preoperative evaluation, admission education, surgical examination, postoperative nursing, and discharge evaluation have not been reduced, which puts forward higher requirements for medical process management.
In terms of optimizing processes, hospitals that perform day surgeries have done their own thing. In 2018, Beijing Tongren Hospital launched a special information system to set up preoperative examination modules for different day surgery diseases, which is convenient for doctors to help patients make appointments quickly in outpatient clinics. The system can also track and feedback in real time, and include the delayed discharge rate, the unplanned re-operation rate, the surgeon's temporary cancellation rate, and the patient's daytime appointment rate into the quality evaluation indicators, and regularly feedback to the clinical department.
In Beijing Tongren Hospital, the day surgery center has a special independent area for one-stop preoperative and postoperative services. Patient check-in, registration and operating theatres are all located on the same platform. "That way patients don't have to travel back and forth in the hospital." Ni Ruxuan said that it is necessary to improve the quality of medical service processes and services in detail, and enhance the public's sense of medical access.
In order to improve the efficiency of diagnosis and treatment, many hospitals have formulated day surgery medical record templates under the premise of following the case management norms to improve the efficiency of surgical case writing; most hospitals have also promoted the development of day surgery by setting assessment indicators and establishing reward mechanisms.
The short and fast nature of day surgery requires that nursing work must keep up. Ma Hongsheng introduced that West China Hospital has re-optimized the nursing process, moving day surgery nursing forward and postponing, so that it can be extended to the patient's family and realize the whole process of management. Before the patient is discharged, the nursing staff will pass on the basic nursing knowledge to the patient or family to improve the patient's self-care ability; for patients who meet the discharge criteria but still need physical or psychological care, the hospital will transfer the patient information back to the community health service agency, and the community medical staff will continue to provide the patient with services including auxiliary treatment, wound care, rehabilitation nursing and so on.
"The bed utilization rate and turnover rate have increased, the limited bed resources of the department have been effectively utilized, the operational efficiency of the hospital has been improved, the workload and performance of medical staff have increased, and the number of operations has increased significantly." Huang Zhigang, vice president of Beijing Tongren Hospital, said. In August 2021, the rhinology department of Beijing Tongren Hospital was just listed in the first month of day surgery, and the volume of rhinal surgery increased by 150% month-on-month. Under the premise of ensuring medical safety, 4 day beds can carry the surgical volume of 20 conventional beds, which greatly alleviates the pressure of waiting for beds.
"The day surgery model has effectively alleviated the problems of 'difficulty in hospitalization' and 'difficulty in surgery', and reduced the economic burden of medical treatment for the masses." Yu Lihua believes that the day surgery management model is expected to become an effective grasp and promote the high-quality development of public hospitals. (Reporters Yang Yanfan and Wang Mingfeng)
Source: People's Daily
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