Evaluation of the effectiveness of staggered admission based on work system in reducing waiting time for day surgery patients_West China Medical Journal

Authors：

LI Lan ¹ , ZHU Min ¹ , LI Shihan ¹ , GU Yufei ¹ , LIU Yang ² ,  HUANG Mingjun ¹

1. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HUANG Mingjun, Email: huangmingjun@wchscu.cn

Keywords：

Day surgery; admission management; staggered admission; work system

DOI：

10.7507/1002-0179.202601145

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Objective To investigate the impact of staggered admission based on work system on waiting time and peak patient flow for day surgery patients. Methods A non-synchronous controlled intervention design was employed. Patients admitted to Day Surgery Center, West China Hospital, Sichuan University between June 11 and June 24, 2024, were designated as the control group, while patients admitted between July 8 and July 21, 2024, constituted the intervention group. The control group followed a centralized admission protocol with an admission window from 08:00 to 09:00, with patients notified of their arrival times by appointment nurses via phone. In contrast, the intervention group implemented a staggered admission schedule based on surgical scheduling, designating arrival times for first surgery, flexible, centralized, and turnover patients, supplemented by phone and text message reminders. The differences in waiting time and patient flow across time segments between the two groups were analyzed using the rank-sum test and chi-square test. Results Finally, 206 patients in the intervention group and 210 patients in the control group were enrolled in the study. The intervention group demonstrated significantly shorter admission waiting time for all admitted patients [22.0 (9.0, 44.0) vs. 35.0 (17.0, 55.0) min], admitted patients with normal conditions [15.0 (8.5, 34.5) vs. 31.0 (16.5, 48.0) min], and admitted patients with abnormal conditions [82.5 (51.0, 99.0) vs. 101.0 (76.0, 133.0) min], with statistically significant differences (P<0.05). During the peak hours from 08:00 to 10:00, the median patient flow in the intervention group was significantly lower than that in the control group (P<0.001). Specifically, during the peak period from 08:31 to 09:00, the median patient flow decreased from 34 (29, 36) to 25 (21, 27) , revealing a statistically significant difference (P<0.001). Conclusions Staggered admission can effectively reduce waiting times for day surgery patients across various admission scenarios and alter the distribution of patient flow during peak periods. Furthermore, the application of work system theory provides a theoretical basis for analyzing the complexity and uncertainty of day surgery admission management.

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4.	張雅琴, 王曉杰, 馬玉芬, 等. 基于分時段入院提高患者入院體驗滿意度的效果評價. 中國醫院管理, 2018, 38(6): 64-65, 68.
5.	熊志剛, 單杰. 分時段醫技檢查預約優化實踐. 中國衛生信息管理雜志, 2021, 18(6): 774-778.
6.	劉沖, 孫燕, 郭欣, 等. 分時段報到候診對不同時間段門診就診量的影響. 中國醫院管理, 2022, 42(4): 61-62.
7.	李蓮, 李春麗, 田曉瓊, 等. 腫瘤日間化療分時段預約系統設計與應用. 中國數字醫學, 2022, 17(12): 63-67.
8.	梁銀華, 張小瓊. 日間手術臨時取消發生率及其原因分析. 中國醫學工程, 2025, 33(7): 63-67.
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12.	羅怡君, 趙靈悅, 劉宏玥, 等. 日間手術預住院統一管理模式的建設和實踐探討. 中國衛生標準管理, 2024, 15(2): 62-65.
13.	譚明英, 羅敏, 王萍, 等. 精細化管理在門診分時段就診的實施現狀與對策探討. 中國醫院管理, 2016, 36(4): 45-46.
14.	吳志丹, 薛錦, 高原. 基于規則庫的智能化醫技預約流程構建. 中國數字醫學, 2021, 16(6): 38-42.
15.	郭莉, 高興蓮, 柯穩, 等. 醫療機構日間手術開展及規范化管理現況調查. 中國護理管理, 2024, 24(4): 576-581.
16.	羅雁平, 劉婕婷, 伍玉媚, 等. 影響日間手術首臺開臺時間的原因分析與對策. 護理實踐與研究, 2019, 16(15): 10-12.
17.	國家衛生健康委醫院管理研究所日間醫療專家庫, 《日間手術圍術期麻醉全流程質量管理專家共識》專家工作組. 日間手術圍術期麻醉全流程質量管理專家共識. 中華醫院管理雜志, 2024, 40(10): 752-760.
18.	殷文文, 王敏丹, 蔣玲, 等. 成人日間手術患者術前評估管理的最佳證據總結. 中華現代護理雜志, 2023, 29(25): 3367-3374.
19.	孫輝, 明敏馨, 馬旭東. 我國二、三級醫療機構日間手術發展現狀分析. 中國醫院管理, 2022, 42(3): 48-51.
20.	蔣麗莎, 馬洪升. 日歸手術——中國日間手術的升華. 華西醫學, 2022, 37(2): 161-164.
21.	張靜, 侯冷晨, 余松軒, 等. 上海市級醫院四級日間手術運行情況分析. 中國衛生質量管理, 2025, 32(7): 1-5.
22.	余瓊, 鄧雁, 馮林美. 老年日間手術患者延遲出院的風險預測模型構建. 護理學雜志, 2022, 37(15): 52-55.
23.	漢業旭, 張檸, 姚崢, 等. 北京某三甲醫院分時段預約就診對門診患者滿意度的影響. 中國醫院, 2022, 26(9): 77-79.

1. 孫輝, 高嗣法, 孫佳璐, 等. 《醫療機構日間醫療質量管理暫行規定》的解讀. 中國衛生質量管理, 2023, 30(5): 30-33.
2. Harries RL, Bradshaw CA, Jones EA, et al. To admit or not to admit on the morning of surgery patients’ perspectives on day of surgery admission. J Perioper Pract, 2013, 23(3): 56-58.
3. 雷甜甜, 黃明君, 梁鵬, 等. 日間手術精準排程的研究現狀及進展. 華西醫學, 2024, 39(2): 308-312.
4. 張雅琴, 王曉杰, 馬玉芬, 等. 基于分時段入院提高患者入院體驗滿意度的效果評價. 中國醫院管理, 2018, 38(6): 64-65, 68.
5. 熊志剛, 單杰. 分時段醫技檢查預約優化實踐. 中國衛生信息管理雜志, 2021, 18(6): 774-778.
6. 劉沖, 孫燕, 郭欣, 等. 分時段報到候診對不同時間段門診就診量的影響. 中國醫院管理, 2022, 42(4): 61-62.
7. 李蓮, 李春麗, 田曉瓊, 等. 腫瘤日間化療分時段預約系統設計與應用. 中國數字醫學, 2022, 17(12): 63-67.
8. 梁銀華, 張小瓊. 日間手術臨時取消發生率及其原因分析. 中國醫學工程, 2025, 33(7): 63-67.
9. Alter S. Work system theory: overview of core concepts, extensions, and challenges for the future. J Assoc Inf Syst, 2013, 14(2): 72-121.
10. Carayon P, Smith MJ. Work organization and ergonomics. Appl Ergon, 2000, 31(6): 649-662.
11. Jewer J. Investigating a work system approach to implement an emergency department surge management system: case study. J Med Internet Res, 2022, 24(8): e37472.
12. 羅怡君, 趙靈悅, 劉宏玥, 等. 日間手術預住院統一管理模式的建設和實踐探討. 中國衛生標準管理, 2024, 15(2): 62-65.
13. 譚明英, 羅敏, 王萍, 等. 精細化管理在門診分時段就診的實施現狀與對策探討. 中國醫院管理, 2016, 36(4): 45-46.
14. 吳志丹, 薛錦, 高原. 基于規則庫的智能化醫技預約流程構建. 中國數字醫學, 2021, 16(6): 38-42.
15. 郭莉, 高興蓮, 柯穩, 等. 醫療機構日間手術開展及規范化管理現況調查. 中國護理管理, 2024, 24(4): 576-581.
16. 羅雁平, 劉婕婷, 伍玉媚, 等. 影響日間手術首臺開臺時間的原因分析與對策. 護理實踐與研究, 2019, 16(15): 10-12.
17. 國家衛生健康委醫院管理研究所日間醫療專家庫, 《日間手術圍術期麻醉全流程質量管理專家共識》專家工作組. 日間手術圍術期麻醉全流程質量管理專家共識. 中華醫院管理雜志, 2024, 40(10): 752-760.
18. 殷文文, 王敏丹, 蔣玲, 等. 成人日間手術患者術前評估管理的最佳證據總結. 中華現代護理雜志, 2023, 29(25): 3367-3374.
19. 孫輝, 明敏馨, 馬旭東. 我國二、三級醫療機構日間手術發展現狀分析. 中國醫院管理, 2022, 42(3): 48-51.
20. 蔣麗莎, 馬洪升. 日歸手術——中國日間手術的升華. 華西醫學, 2022, 37(2): 161-164.
21. 張靜, 侯冷晨, 余松軒, 等. 上海市級醫院四級日間手術運行情況分析. 中國衛生質量管理, 2025, 32(7): 1-5.
22. 余瓊, 鄧雁, 馮林美. 老年日間手術患者延遲出院的風險預測模型構建. 護理學雜志, 2022, 37(15): 52-55.
23. 漢業旭, 張檸, 姚崢, 等. 北京某三甲醫院分時段預約就診對門診患者滿意度的影響. 中國醫院, 2022, 26(9): 77-79.

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