ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
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.
The strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.
Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery. Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected. According to whether the patients were discharged on the same day, they were divided into same-day discharge group and delayed discharge group. The differences in gender, age, first surgical procedure (surgical method, hepatectomy or not, intraoperative choledochoscopy or not), choledochoscopic lithotomy (first choledochoscopy or not, lithotomy method, number of stones and site of stones), operation duration, hospital stay, hospital cost, and postoperative complications (fever, poor drainage, and T tube dislodgement) between the two groups were compared and analyzed. Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy. Results All patients were admitted and discharged within 24 h, among them, 557 cases (91.8%) were discharged on the same day and 50 cases (8.2%) were discharged the next day. The results of multiple logistic regression analysis showed that choledochoscopy for the first time [odds ratio (OR)=2.359, 95% confidence interval (CI) (1.303, 4.273), P=0.005], lithotomy after electrohydraulic lithotripsy [OR=1.857, 95%CI (1.013, 3.402), P=0.045], and multiple stones (number of stones ≥2) [OR=2.741, 95%CI (1.194, 6.288), P=0.017] were independent risk factors for delayed discharge. Conclusion The operation of same-day choledochoscopic lithotomy is mature, and choledochoscopy for the first time, lithotomy after electrohydraulic lithotripsy, and multiple stones (number of stones ≥2) are independent risk factors for delayed discharge.
Objective To explore the application of quality control circle in reducing the same-day cancellation rate of day surgery. Methods A quality control circle team was set up, and determined the theme of reducing the same-day cancellation rate of day surgery. A survey was conducted among all patients who had made appointments for day surgeries at the First Affiliated Hospital of the Air Force Military Medical University between August and October 2023. The number of patients who cancelled their surgeries on the day and the reasons for their cancellations were recorded. Based on the ten steps of the quality control circle, relevant measures and improvement processes were formulated. In March 2024, the same-day cancellation rate of day surgery after the quality control circle activity was analyzed. Results The same-day cancellation rate decreased from 2.39% to 0.67%, the target achievement rate was 135.43%, and the progress rate was 71.97%. Conclusion The quality control circle activity can effectively reduce the same-day cancellation rate of day surgery.
Objective To analyze the influencing factors of single-center day surgery patients who are discharged from the hospital on the same-day, in order to provide reference and basis for the clinical practice of follow-up day surgery. Methods The electronic medical records of patients who underwent day surgery in the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University between February and October 2021 were analyzed retrospectively. The patients were divided into the same-day discharge group and non-same-day discharge group. The baseline data and perioperative indicators of the patients were analyzed. Results A total of 857 patients were included, including 264 patients (30.81%) in the same-day discharge group and 593 patients (69.19%) in the non-same-day discharge group. Univariate analysis showed that there were significant differences between the two groups in gender, age, body mass index, whether the first one, disease classification, anesthesia method, and intraoperative blood loss (P<0.05). Logistic regression analysis showed that gender, whether the first one, disease classification, surgical grade, anesthesia method, and intraoperative blood loss were independent factors affecting the delayed discharge of patients undergoing daytime surgery (P<0.05). Conclusions There are many factors that affect day surgery patients’ discharge. It is suggested that more rigorously screen patients for day surgery, improve medical technology, strengthen out-of-hospital continued care, and optimize management procedures, so as to shorten the time of patients in hospital and provide more information for patients, and provide more efficient and convenient medical services for patients.
Same-day surgery mode is an efficient medical mode, and the key point of its management is multidisciplinary collaboration optimization of the process and integration of enhanced recovery after surgery concept. This paper introduces the establishment of multidisciplinary collaboration system, clinical pathway maintenance, patient visit procedure optimization, preoperative and postoperative care and follow-up management of same-day surgery mode for children with strabismus correction under general anesthesia at West China Tianfu Hospital of Sichuan University, aiming to promote the further improvement of the pediatric same-day surgery process and provide a reference for the promotion of the pediatric same-day surgery mode.
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 analyze the current status of day surgery in West China Hospital of Sichuan University and compare it with the Recommended Catalogue of Day Surgery (2022 Edition), in order to provide reference for the update and expansion of day surgery procedures in hospitals. Methods The day surgical procedures carried out in West China Hospital of Sichuan University from October 2009 to July 2023 were collected. The day surgical procedures were classified based on surgical specialties, types of procedures, methods of operation, and surgical grading, etc. The day surgical procedures in West China Hospital of Sichuan University were compared with those in the Recommended Catalogue of Day Surgery (2022 Edition). Results A total of 576 types of daytime surgeries were carried out in West China Hospital of Sichuan University, involving 15 specialties. A total of 662 types of day surgeries were recommend in the nationally recommended catalogue for daytime surgery, involving 11 specialties. Among the nationally recommended surgical procedures, West China Hospital of Sichuan University had carried out 233 types of surgical procedures, and 26 additional types of surgical procedures were carried out as outpatient surgeries. According to the classification of surgical difficulty, the Level Ⅱ and Ⅲ surgeries were mainly carried out in West China Hospital of Sichuan University, and the Level Ⅱ surgeries were mainly recommend in the nationally recommended catalogue for day surgery. Conclusions The high-quality development of day surgery in China should not be limited to the supplement of surgical procedures. It is necessary to strive to increase the proportion of minimally invasive and fourth-level surgeries while ensuring medical quality and safety, and improve the overall medical level of day surgery.