ObjectiveTo analyze the current situation of antimicrobial agents using in day surgery patients to guide the rational use of antimicrobial agents in day surgery.MethodsThe day surgery performed in Day Surgery Center of Xiangya Hospital of Central South University from June 2016 to September 2017 was selected. We retrospectively collected and analyzed patients’ hospitalization data and return visit data, statistically analyzed their use of antimicrobial agents, explored whether there was an unreasonable phenomenon in the use of antimicrobial agents, and analyzed the reasons.ResultsThere were 4 054 surgeries included in this study, and 1 293 patients using antimicrobial agents, the use rate of antimicrobial agents in day surgery patients reached 31.89%. Aseptic, clean-contaminated, contaminated and dirty surgery accounted for 12.22%, 65.20%, 7.27%, and 15.31% separately. Whether the application of antimicrobial agents in aseptic surgery patients had no effect on the outcome of the incision (P=0.073). The most common type of antimicrobial agents used by patients are cephalosporins (57.50%), mainly used as single drugs (97.91%) and mostly oral used in patients’ home. Most of the sources of antimicrobial agents were purchased by patients after they were discharged from the hospital (65.43%). The antimicrobial agents more used by Stemmatological Department (23.98%), Ear/Nose/Throat Department (22.58%) and Obstetrics and Gynecology Department (22.51%). The average used time of antimicrobial agents was (5.37±1.86) days, and 7.42% of patients still had surgical site infections after the use of prophylactic antimicrobial agents, most of them from General Surgery Department.ConclusionsThe unreasonable phenomena in the use of antimicrobial agents in patients with day surgery include: a high proportion of preventive medications for clean-contamination surgery, a high level of initial medication, and most patients take oral medications at home and lack of guidance, and long medication time. There is an urgent need for scientific guidance on the use of antimicrobial agents for patients undergoing day surgery.
Objective To establish an evaluation index system for the quality and safety of day surgery, and provide standard and professional quantitative bases for monitoring and management of day surgery quality. Methods From December 2021 to May 2022, based on the frame work of the three-dimensional “structure-process-outcome” quality model, two rounds of Delphi method interviews were conducted with 15 day surgery-related management experts, and analytic hierarchy process was used to calculate the weight of each index. Results The effective questionnaire recovery rates of the two rounds of surveys were both 100%; the expert authority coefficients were 0.94 and 0.98, respectively; the variation coefficients were 0.00-0.30 and 0.00-0.24, respectively; the Kendall coordination coefficients were 0.382 (P<0.05) and 0.266 (P<0.05), respectively; and the consistency ratios of all levels were less than 0.1. The final day surgery quality and safety evaluation index system included 3 first-level indicators, 10 second-level indicators, and 43 third-level indicators. Conclusions The quality and safety evaluation index system of day surgery is scientific, reasonable and comprehensive. It can provide a reference for the quality and safety evaluation of day surgery and solidly promote the high-quality development of public hospitals.
Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.
Objective To explore the effect of lean management on patients’ safety, medical quality, and satisfaction in day surgery ward. Methods The patients underwent day surgery between May 4th, 2017 and April 30th, 2018 were selected as the subjects (the lean management of day surgery ward implemented on November 1st, 2017). The patients underwent day surgery between May 4th and October 31st, 2017 were taken as the control group (n=2 864), and the ones between November 1st, 2017 to April 30th, 2018 were taken as the observation group (n=2 705). The following data between the two groups were compared: the cancellation rate of day surgery, the 24-hour delayed discharge rate, the rate of 12-hour median or severe pain after surgery, the rate of 12-hour postoperative nausea and vomiting, the awareness rate of health education, the patients’ satisfaction, and the incidence of adverse events.Results Compared with those in the control group, the cancellation rate of surgery (4.81% vs. 6.25%), the 24-hour delayed discharge rate (2.76% vs. 4.28%), the 12-hour median or severe pain after surgery (5.55% vs. 8.31%), the rate of 12-hour postoperative nausea and vomiting (5.86% vs. 7.71%) decreased in the observation group, and the differences were statistically significant (P<0.05). The awareness rate of health education increased from 92.18% to 98.02% after the implementation of lean management, the patients’ satisfaction increased from 92.48±2.58 to 96.53±1.64 after the implementation of lean management, and the differences were statistically significant (P<0.05). The incidences of adverse events in the two groups were not statistically different (0.16% vs. 0.41%, P>0.05). Conclusion The implementation of lean management model can insure the medical safety and quality of day surgery, and improve overall work efficiency and the patients’ medical service experience in day surgery ward.
ObjectiveTo explore and analyze the current situation of discharge readiness and delayed discharge for patients undergoing ambulatory thyroid malignancy surgery.MethodsBy convenient sampling, 284 thyroid malignancy patients who were admitted to the day surgery ward of Xiangya Hospital, Central South University from September 1st to December 30th, 2018 were selected as the research objects. The general information questionnaire and Readiness for Hospital Discharge Scale (RHDS) were used as the research tools. Descriptive statistical analysis was used to analyze the demographic statistics of the patients, and the differences of different dimension scores and total scores of RHDS were analyzed based on the basic information of patients.ResultsThe total score of RHDS was 8.66±0.60 for patients, including 6.31±0.74 for dimension of physical condition, 9.49±0.87 for dimension of disease knowledge, 9.20±0.99 for dimension of coping ability after discharge, and 9.63±0.74 for dimension of expected social support. The delayed discharge rate was 2.1%. There was no significant difference in the scores of different dimensions or total scores in RHDS of patients undergoing ambulatory thyroid malignancy surgery with different gender, age, education level or whether there was a special person to take care of them (P>0.05). There were differences between patients with delayed discharge and the ones without delayed discharge in the three dimensions namely physical condition, disease knowledge, and coping ability, as well as the total scores (P<0.05), while there was no statistically significant difference in the scores of expected social support dimension (P>0.05).ConclusionsThe discharge readiness for patients undergoing ambulatory thyroid malignancy surgery is good. The medical staff should provide health intervention measures according to the specific situation of patients, so as to improve the quality of discharge guidance, and ensure the safety of patients.
ObjectiveTo break through the key problem in the process of ambulatory surgery operation and management, improve the operational efficiency of hospital, and ensure the quality and safety of medical care through new established ambulatory surgery informative platform.MethodsThrough the analysis of medical requirements and process optimization in ambulatory surgery in Xiangya Hospital, Central South University from March to April, 2020, we constructed an ambulatory surgery informative platform centered on patient behavior tracking.ResultsThere wasa significant difference in the reception time of different appointment modes before and after the launch of information platform [(290.45±50.35) vs. (158.58±40.27) s; t=16.040, P<0.001]. After the platform system went online, patients’ satisfaction with the treatment process, appointment waiting time, and overall satisfaction were higher than before (P<0.05); there was no significant difference in patients’ attitude towards medical staff before and after the system went online (P>0.05). The results of medical staff’s work experience after the system went online showed that the use of information platform could make the work more efficient (91.09%), the process more reasonable (91.09%), accurately and timely grasp the patient’s information (95.05%), guarantee the medical quality and safety (96.04%), and reduce the medical cost (88.12%).ConclusionThe ambulatory surgery informative platform improved our work efficiency and patients’ satisfaction, assured the quality and safety of medical care, and strengthen the multi-disciplinary synergy at the same time.
Objective To decrease broken appointment rate of day surgery by conducting quality control circle (QCC) activities, in order to make full use of quality resources. Methods All the patients who made an appointment in the day surgery units in Xiangya Hospital of Central South University between July and September 2015 were chosen as the research subjects. By counting the number of patients who broke the appointment, we analyzed the broken appointment rate. In October 2015, we established a QCC management team to deal with the phenomenon of high broken appointment rate, and set up a theme of " decreasing broken appointment rate of day surgery”. Related regulations were implemented and procedures were optimized. In December 2015, we compared the broken appointment rates before and after the implementation of QCC activities among all 1 879 patients. Results After the implementation of QCC activities, the day surgery broken appointment rate decreased from 17.16% to 6.06%, and the target achievement rate was 122.65%. Conclusion QCC activities can effectively reduce day surgery broken appointment rate.
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.
Objective To explore the procedure and effectiveness of sequential reduction and fixation for zygomatic complex fractures. Methods Between March 2004 and February 2012, 32 patients with zygomatic complex fractures were treated. There were 28 males and 4 females with a median age of 29 years (range, 17-55 years). Fractures were caused by traffic accident in 29 cases and by tumble in 3 cases. The time between injury and admission was 1-12 days (mean, 3 days) in 28 fresh fractures and 22-60 days (mean, 40 days) in 4 old fractures. All patients were diagnosed by clinical symptom and CT scan. Coronal scalp incision, lower eyelid aesthetic incision, and intraoral incision were used to expose the zygomatic bone segments. The sequence of fractures reduction and fixation was horizontal first, and then longitudinal. In horizontal orientation, reduction and simultaneous fixation started from the root of the zygoma, to zygomatic arch, body of the zygoma, and inferior orbital rim in turn. Longitudinally, fracture reduction of zygomatico-frontal suture and orbital posterolateral walls was done first, followed by fracture reduction of zygomaticomaxillary buttress. Results Primary healing of incision was obtained in all 32 cases, without complications of maxillary sinus fistula and infection. Eighteen patients were followed up 6 months to 6 years with a median time of 32 months. All the patients gained satisfactory results with normal zygomatic contour and symmetric midface. All patients restored normal mouth opening. No eye and vision damage occurred. Frontal disappearance and brow ptosis were observed in 2 cases. Hair loss (2-3 mm) was seen at the site of coronal scalp incision, without scar hyperplasia; there was no obvious scar at lower eyelid. CT and X-ray films showed bony healing at 6 months after operation. Conclusion Sequential reduction and fixation is accord with the mechanical characters of complicated zygomatic fractures. It is very easy to achieve anatomic reduction of the bone segments and facial symmetry.