Day surgery mode effectively alleviates the problems of "difficult hospitalization" and "difficulty in surgery"
Short waiting time and low economic burden (Health Focus)
Our reporter Yang Yanfan Wang Mingfeng "People's Daily" (page 15 on April 22, 2022)
On the afternoon of April 8, at Beijing Tongren Hospital Affiliated to Capital Medical University, the 6-year-old Nuonuo completed the day surgery for adenoid hypertrophy.
The postoperative observation was normal, and Nuonuo was discharged from the hospital on the morning of April 9, and the length of stay in the hospital did not exceed 24 hours.
"It is very convenient to make appointments for preoperative examinations and operation times in advance, and there is no need to wait for a bed in the hospital." Nuonuo's father told reporters.
Day surgery refers to the operation or operation (excluding outpatient surgery) that the patient is admitted and discharged within one day (24 hours) according to the diagnosis and treatment plan. In special cases that require delayed hospitalization due to illness, the hospitalization time does not exceed 48 hours.
Day surgery is often compared to playing volleyball and is popular with hospitals and patients because of its short time, high efficiency, fast bed turnover, and low patient payment.
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 "Promotion Action for High-Quality Development of Public Hospitals (2021-2025)" issued by the National Health and 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 the hospital?
The journalist made an interview about this.
Significantly shorten the waiting and hospitalization time of patients and reduce the economic burden
At West China Hospital of Sichuan University, patient Ms. Li made an appointment for breast cancer day surgery on April 7.
"I thought I was going to have a major operation and I would have to be hospitalized for a long time. I heard that day surgery could be done, but I was a little worried at first." Ms. Li said that the communication between the doctors before the operation was very meticulous, and she had a thorough understanding of the operation plan. The psychological burden has also been reduced a lot.
Ms. Li told reporters that the preparation process for day surgery is very convenient: after seeing a doctor in the outpatient department, make an appointment for the surgery time on the mobile APP, wait for the doctor to prescribe all the pre-operative inspection items, and complete the inspection in sequence; two days in advance, the hospital reminds you to Do a good job of nucleic acid inside; the day before the operation, the day surgery center will call again to confirm whether there is a cold or not.
"The home environment is better, which is conducive to postoperative recovery, and daytime surgery is also more convenient for family members to accompany them, saving the trouble of going back and forth to the hospital." Ms. Li's husband said.
In March 2012, the former National Health and Family Planning Commission Health Development Research Center took the lead in organizing Shanghai Shenkang Hospital Development Center, Sichuan University West China Hospital, Beijing Tongren Hospital and other units to establish China Day Surgery Cooperation Alliance.
According to the "China Ambulatory Surgery Development Report 2020", from 2013 to 2018, the number of medical institutions performing ambulatory surgery across the country increased by 10.58 times, and the number of ambulatory surgery cases increased by 5.86 times.
"In the past, in the concept of many patients, hospitalization was necessary before surgery. After hospitalization, various examinations were done first, and the operation was arranged after the results came out. The time in the hospital was longer." Yu Lihua, deputy director of the Pharmaceutical Cost and Price Research Department of the Health Development Research Center of the National Health and Health Commission, said that the process of day surgery was optimized, and the preoperative examination and evaluation were completed in the outpatient clinic, which effectively reduced the hospital stay.
After day surgery, the patient's waiting time for a bed was significantly shorter.
Ni Ruyang, director of the medical department of Beijing Tongren Hospital, said that in the past, patients waiting for surgery in the hospital's rhinology department had to wait an average of more than 3 months before being admitted to the hospital from the issuance of a hospitalization certificate.
Now, it is basically a week to two weeks from the start of the preoperative examination to complete the operation.
It is an ideal day surgery mode.
"But some diseases are quite special. For example, most of the rhinoplasty operations are performed under general anesthesia. The nasal cavity must be tamped to stop the bleeding after the operation. It is necessary to stay under observation overnight to make sure that there is no active bleeding before leaving the hospital. Therefore, it is more suitable for the operation in the afternoon. After one night of observation in the hospital, he was discharged before noon the next day, within 24 hours." Ni Ruyang said.
Shorter hospital stays and lower medical costs are the advantages of day surgery.
Ma Hongsheng, director of the Day Surgery Center of West China Hospital of Sichuan University, introduced that according to preliminary statistics, compared with non-day surgery, the average medical expenses of patients dropped by about 20%.
For example, laparoscopic cholecystectomy patients save an average of about 22%.
In addition, day surgery also reduces the indirect burden on patients, such as family members' round-trip transportation costs and lost work costs.
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, or DRG (disease diagnosis-related grouping), DIP (big data-based disease) payment, day surgery has been paid. Surgery is 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 are further standardized and standardized, and medical quality and safety measures are increasingly complete
Which diseases can be included in the scope of day surgery, and how to ensure the medical safety of patients?
This is the biggest public concern about performing day surgery.
A few days ago, the National Health and Health Commission released the "Recommended Catalogue of Day Surgery (2022 Edition)". Based on the 43 day surgery procedures recommended in 2016 and the 77 day surgery procedures recommended in 2019, the third A total of 708 day surgery operation items have been approved, which further standardizes and standardizes the day surgery procedures.
According to industry insiders, hospitals generally choose diseases or surgical procedures with mature medical technology, relatively low surgical risks, and few postoperative complications.
Ma Hongsheng told reporters that different hospitals are good at different departments and techniques, and they will choose the type of surgery according to their own medical level.
Since 2009, West China Hospital has performed more than 300 day surgery procedures.
After continuous accumulation of experience, more diseases will also enter the category of day surgery.
Ensuring the quality and safety of medical care is the premise of day surgery.
Generally speaking, hospitals that carry out day surgery have established relevant quality and safety management and guarantee systems.
For example, the Ambulatory Surgery Quality Management Committee of Beijing Tongren Hospital has clearly stipulated the access standards for diseases, doctors and patients.
Hospitals require experienced and senior physicians to perform day surgery. Doctors not only need to be qualified for surgery or related operations, but also need to have strong doctor-patient communication skills.
The exit criteria are equally important. After the patients leave the operating room, they will be monitored in the recovery room for about an hour and a half, and some patients will have to go back to the ward for monitoring.
"We have established an emergency plan. If there is a sudden change in the condition, it will be evaluated and dealt with in a timely manner. The medical staff will make a telephone return visit to the patient to understand the recovery situation. A special service phone number has also been set up to provide 24-hour emergency consultation services for discharged patients to ensure that Medical safety," said Li Ming, director of the day surgery center at Beijing Tongren Hospital.
"The purpose of day surgery in the hospital is to serve patients efficiently and safely." Yu Lihua said that day surgery involves multidisciplinary collaboration in clinical, anesthesia, nursing, and rehabilitation, and is a platform that serves all operating departments in the hospital.
For some specialties with strong specialties, if the patient does not have the conditions for suture removal and review at home after surgery, it is not suitable to choose day surgery.
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 the more efficient use of medical resources
With limited bed resources, day surgery can effectively improve hospital operation efficiency and meet the needs of more patients. The benefits are obvious.
However, the time spent in the hospital for day surgery has been shortened, and the outpatient visits, bed reservations, preoperative evaluation, admission education, surgical inspection, postoperative care, and discharge evaluation have not been reduced, which puts forward higher requirements for medical process management.
In terms of optimizing the process, hospitals that implement day surgery have each come up with great ideas.
In 2018, Beijing Tongren Hospital launched a special information system, and set up a preoperative examination module for different day surgery diseases, which is convenient for doctors to help patients make quick appointments in outpatient clinics.
The system can also track and provide feedback in real time, and incorporate the delayed discharge rate, unplanned reoperation rate, surgeon’s temporary cancellation rate, and patient’s day-time no-show rate into quality evaluation indicators, and feedback to clinical departments on a regular basis.
In Beijing Tongren Hospital, the day surgery center has a dedicated area for one-stop preoperative and postoperative services.
Patient check-in, registry and operating room are all located on the same level platform.
"In this way, patients don't need to go back and forth in the hospital." Ni Ruyang said that it is necessary to improve the medical service process and service quality from the details, and enhance the people's sense of obtaining medical treatment.
In order to improve the efficiency of diagnosis and treatment, many hospitals have developed day surgery medical record templates under the premise of following medical record management standards to improve the efficiency of surgical medical record writing; most hospitals also promote the development of day surgery by setting assessment indicators and establishing reward mechanisms.
The characteristics of day surgery are short and smooth, and it is required that nursing work must keep up.
Ma Hongsheng introduced that West China Hospital has re-optimized the nursing process, moving forward and delaying day surgery nursing, so that it can be extended to the patient's family and realize the whole process management.
Before the patient is discharged from the hospital, the nursing staff will teach the basic nursing knowledge to the patient or their family members to improve the patient's self-care ability; for patients who meet the discharge standards but still need physical or psychological care, the hospital will transfer the patient's information to the community health service institution, and the Community medical staff continue to provide patients with services including adjuvant therapy, wound care, and rehabilitation care.
"The utilization rate and turnover rate of hospital beds have increased, the limited bed resources of the departments have been effectively utilized, the operation efficiency of the hospital has been improved, the workload and performance of medical staff have improved, and the number of surgeries has increased significantly." said Huang Zhigang, vice president of Beijing Tongren Hospital.
In August 2021, the first month that Beijing Tongren Hospital's Rhinology Department was listed for day surgery, the volume of nose surgery increased by 150% month-on-month.
Under the premise of ensuring medical safety, 4 day beds can carry the operation volume of 20 conventional beds, which greatly relieves the pressure of staying in bed.
"The day surgery model has effectively alleviated the problems of 'difficulty in hospitalization' and 'difficulty in surgery', and reduced the economic burden of the masses for medical treatment." Yu Lihua believes that the day surgery management model is expected to become an effective starting point and promote the high-quality development of public hospitals.