综合性医院日间手术中心的建设和运营管理
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摘要
日间手术是国家医药卫生体制改革推行的重点任务之一,在我国尚处于快速发展阶段,探索满足临床质量与安全、行之有效的日间病房管理模式是推广日间手术过程中大型综合性医院需要承担的职责。综合性医院日间手术中心在建设和运营过程中需要不断探索,引入精益思维策略,通过职业培训塑造凝聚力强的专门日间手术团队,建立日间病房与专科之间良性互动的协调和激励机制;根据日间手术的自身特点,建立日间手术的临床路径管理和全病程康复与健康教育体系;制订日间手术病历书写规范;建立日间手术的效率与安全质量监测体系,夯实日间手术质量和安全基础,建立符合我国医疗特点和医院学科特色的日间手术发展模式。
Day surgery is one of the key tasks of the national medical reform. It is still in the stage of rapid developing in the country. It is the responsibility of the large general hospitals to explore the effective management mode of the day surgery center to meet the clinical quality and safety. During the establishment and management of day surgery center in general hospital, it is needed to build a strong specialized day surgery team through professional training, and to establish a coordination and incentive mechanism for the cooperation between the day ward and the specialized subjects by introducing lean thinking strategy. According to the characteristics of day surgery, the clinical pathway management and the whole course rehabilitation and the health education system of day surgery are established. The formulate norms for medical records of day surgery will be built. The monitoring system for the efficiency and safety of day surgery is established to improve the medical quality and safety of day surgery. As a result, the model of day surgery that conforms to the medical characteristics of China will be established.
Day surgery is one of the key tasks of the national medical reform. It is still in the stage of rapid developing in the country. It is the responsibility of the large general hospitals to explore the effective management mode of the day surgery center to meet the clinical quality and safety. During the establishment and management of day surgery center in general hospital, it is needed to build a strong specialized day surgery team through professional training, and to establish a coordination and incentive mechanism for the cooperation between the day ward and the specialized subjects by introducing lean thinking strategy. According to the characteristics of day surgery, the clinical pathway management and the whole course rehabilitation and the health education system of day surgery are established. The formulate norms for medical records of day surgery will be built. The monitoring system for the efficiency and safety of day surgery is established to improve the medical quality and safety of day surgery. As a result, the model of day surgery that conforms to the medical characteristics of China will be established.
引文
1Fox JP, Vashi AA, Ross JS, et al. Hospital-based, acute care after ambulatory surgery center discharge. Surgery, 2014, 155(5):743-753.
2Rosero EB, Joshi GP. Hospital readmission after ambulatory laparoscopic cholecystectomy:incidence and predictors. J Surg Res,2017, 219:108-115.
3李志超,马洪升,杨建超,等.日间手术医疗质量与安全保障系统构建的对策研究.华西医学, 2017, 32(4):493-496.
4 刘蔚东.日间手术合理调配诊疗资源.中国卫生人才, 2016(3):27-30.
5马洪升.日间手术的管理.华西医学, 2017, 32(4):481-482.
6国家卫生计生委,国家中医药局.关于印发进一步改善医疗服务行动计划的通知(国卫医发[2015]2号).(2015-01-12)[2019-01 -01]. http://www.nhfpc.gov.cn/yzygj/s3593g/201501/5584853cfa254d1aa4e38de0700891fa.shtml.
7国务院办公厅.国务院办公厅关于城市公立医院综合改革试点的指导意见(国办发[2015]38号).(2015-05-06)[2019-01-01].http://www.gov.cn/zhengce/content/2015-05/17/content_9776.htm.
8 税章林,石应康,马洪升,等.日间手术诊疗模式的实践与本土化的思考.中国医院, 2012, 16(4):38-40.
9林夏,马洪升,王琪,等.提升我国日间手术管理水平的思考与建议.中国医院管理, 2017, 37(7):41-42.
10刘蔚东,李萍,谭亮,等.日间手术的术式准入与挑战.华西医学,2015, 30(5):820-823.
11 毛林锋,袁正泰,刘序,等.甲状腺日间手术的临床初探.中南大学学报(医学版), 2016, 41(3):305-312.
12Kitchiner DJ, Bundred PE. Clinical pathways. Med J Aust, 1999,170(2):54-55.
13Cheah TS. The impact of clinical guidelines and clinical pathways on medical practice:effectiveness and medico-legal aspects. Ann Acad Med Singapore, 1998, 27(4):533-539.
14林莉,莫洋,石峰华,等.日间手术出院后并发症分析.中国现代医学杂志, 2016, 26(17):90-93.
15Rajala M, Kaakinen P, Fordell M, et al. The quality of patient education in day surgery by adult patients. J Perianesth Nurs, 2018,33(2):177-187.
16莫洋,瞿宏颖,吴思容,等.全程管理模式在日间手术病房管理中的应用.中华现代护理杂志, 2018, 24(15):1748-1752.
17Aubrun F, Ecoffey C, Benhamou D, et al. Perioperative pain and post-operative nausea and vomiting(PONV)management after day-case surgery:the SFAR-OPERA National study. Anaesth Crit Care Pain Med, 2018. https://www.sciencedirect.com/science/article/pii/S2352556817303697.
18Mayo I, Lizarondo L, Stokan M. Experiences of adult patients in discharge and recovery from day surgery:a systematic review protocol of qualitative evidence. JBI Database System Rev Implement Rep, 2018. https://insights.ovid.com/crossref?an=01938924-900000000-99974.
19莫洋,陈亚玲,石峰华,等.开展品管圈活动降低日间手术爽约率的效果分析.华西医学, 2017, 32(4):488-492.
20 彭静,王曙红,莫洋,等.输尿管软镜钬激光碎石取石术的日间手术与专科住院手术的卫生经济学评价.华西医学, 2017, 32(11):1675-1679.
21莫洋,瞿宏颖,吴思容,等.膝关节镜日间手术卫生经济学效果分析.华西医学, 2016, 31(4):642-644.
2Rosero EB, Joshi GP. Hospital readmission after ambulatory laparoscopic cholecystectomy:incidence and predictors. J Surg Res,2017, 219:108-115.
3李志超,马洪升,杨建超,等.日间手术医疗质量与安全保障系统构建的对策研究.华西医学, 2017, 32(4):493-496.
4 刘蔚东.日间手术合理调配诊疗资源.中国卫生人才, 2016(3):27-30.
5马洪升.日间手术的管理.华西医学, 2017, 32(4):481-482.
6国家卫生计生委,国家中医药局.关于印发进一步改善医疗服务行动计划的通知(国卫医发[2015]2号).(2015-01-12)[2019-01 -01]. http://www.nhfpc.gov.cn/yzygj/s3593g/201501/5584853cfa254d1aa4e38de0700891fa.shtml.
7国务院办公厅.国务院办公厅关于城市公立医院综合改革试点的指导意见(国办发[2015]38号).(2015-05-06)[2019-01-01].http://www.gov.cn/zhengce/content/2015-05/17/content_9776.htm.
8 税章林,石应康,马洪升,等.日间手术诊疗模式的实践与本土化的思考.中国医院, 2012, 16(4):38-40.
9林夏,马洪升,王琪,等.提升我国日间手术管理水平的思考与建议.中国医院管理, 2017, 37(7):41-42.
10刘蔚东,李萍,谭亮,等.日间手术的术式准入与挑战.华西医学,2015, 30(5):820-823.
11 毛林锋,袁正泰,刘序,等.甲状腺日间手术的临床初探.中南大学学报(医学版), 2016, 41(3):305-312.
12Kitchiner DJ, Bundred PE. Clinical pathways. Med J Aust, 1999,170(2):54-55.
13Cheah TS. The impact of clinical guidelines and clinical pathways on medical practice:effectiveness and medico-legal aspects. Ann Acad Med Singapore, 1998, 27(4):533-539.
14林莉,莫洋,石峰华,等.日间手术出院后并发症分析.中国现代医学杂志, 2016, 26(17):90-93.
15Rajala M, Kaakinen P, Fordell M, et al. The quality of patient education in day surgery by adult patients. J Perianesth Nurs, 2018,33(2):177-187.
16莫洋,瞿宏颖,吴思容,等.全程管理模式在日间手术病房管理中的应用.中华现代护理杂志, 2018, 24(15):1748-1752.
17Aubrun F, Ecoffey C, Benhamou D, et al. Perioperative pain and post-operative nausea and vomiting(PONV)management after day-case surgery:the SFAR-OPERA National study. Anaesth Crit Care Pain Med, 2018. https://www.sciencedirect.com/science/article/pii/S2352556817303697.
18Mayo I, Lizarondo L, Stokan M. Experiences of adult patients in discharge and recovery from day surgery:a systematic review protocol of qualitative evidence. JBI Database System Rev Implement Rep, 2018. https://insights.ovid.com/crossref?an=01938924-900000000-99974.
19莫洋,陈亚玲,石峰华,等.开展品管圈活动降低日间手术爽约率的效果分析.华西医学, 2017, 32(4):488-492.
20 彭静,王曙红,莫洋,等.输尿管软镜钬激光碎石取石术的日间手术与专科住院手术的卫生经济学评价.华西医学, 2017, 32(11):1675-1679.
21莫洋,瞿宏颖,吴思容,等.膝关节镜日间手术卫生经济学效果分析.华西医学, 2016, 31(4):642-644.
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