Objective To explore the short-term effects of reengineering for the first-surgery preparation process in day surgery management. Methods In July 2019, West China Hospital of Sichuan University began to reconstruct a standard process for the first-surgery preparation process in day surgery based on the theory of process reengineering. Patients who underwent the first general anesthesia operation on the day at the Day Surgery Center between February and June 2019 were selected as the pre-reengineering group, and those between July and November 2019 were selected as the post-reengineering group. The time intervals for each stage of the surgical process and the incidences of delays in each stage were compared between the two groups. Results A total of 633 patients were included, with 309 in the pre-reengineering group and 324 in the post-reengineering group. The time from arrival to admission for the first patient [(30.24±7.86) vs. (22.45±10.65) min, P<0.001], time from admission to doctor’s orders [(9.42±7.07) vs. (5.45±5.86) min, P<0.001], waiting time before entering the operating room after nursing preparation [(23.67±17.59) vs. (18.46±19.60) min, P=0.001], and total waiting time from admission to entering the operating room [(73.42±18.46) vs. (65.27±21.00) min, P<0.001] in the post-reengineering group were all shorter than those in the pre-reengineering group. The incidence of patients admitted after 07:50 (2.3% vs. 0.3%, P=0.034) and the incidence of nurses’ preparation completion time extending beyond 08:20 (6.1% vs. 2.5%, P=0.022) in the post-reengineering group were lower than those in the pre-reengineering group. Conclusion The reengineering of the first-surgery preparation process significantly improves the management of day surgery across multiple stages of the process, reducing patient waiting times and minimizing delays in admission, order processing, and nursing preparations that may affect patients’ punctual entry into the operating room.
摘要:目的:優化藥品單劑量調劑,加強信息化管理,優化操作流程。 方法:采用東華軟件:住院藥房管理系統(DTCISIP)和住院藥品調劑系統(DTCISID) 實施。結果:東華軟件成功實現了我院4300病床的藥品單劑量調劑及各部門管理聯網,優化了操作系統及流程,且系統運行穩定。結論:東華軟件進行藥品單劑量調劑,加強了藥品的出入管理,優化了藥品單劑量調劑的操作流程。Abstract: Objective: To improve united dose dispension, enhance the utilization of information technology in management of united dose dispension and optimize clinical human resource. Methods: DONG HUA software, which included DTCISIP system(system for management of medicine for inpatients) and DTCISID system(system for dispension of medicine for in-patients), was used to carry out united dose dispension. Results: United dose dispension of 4300 beds were easy to achieve by using DONG HUA software. The system worked smoothly and received lots of praise. Conclusion: The management of medicine is enhanced and clinical human resource is optimized by using DONG HUA software to carry out united dose dispension
ObjectiveTo develop a transparency evaluation tool 2.0 of clinical practice guidelines (CPGs) oriented by public trust. MethodsThe Delphi method was employed to score and select the importance and operability of evaluation indicators. The analytic hierarchy process was used to determine the weights of the indicators. And the final evaluation indicator system was determined through expert consensus meeting. ResultsIt constructed two first-level indicators including conflict of interest and formulation process, and six second-level indicators, including guideline developers, reviewers, protocol and registration, evidence production, recommendation formation, and external review. Based on the second-level indicators, a total of 21 third-level indicators were constructed from the perspectives of disclosure and management. The logical structure of the tool is rigorous and harmonious. ConclusionThe CPGs transparency assessment tool 2.0 developed in this study provides measurement standards and an evaluation framework for assessing transparency in CPGs.
According to the potential risks in the hospital hazard vulnerability analysis (HHVA) process, Jingmen People’s Hospital introduced the failure mode and effect analysis (FMEA) method to optimize. Through the establishment of a multidisciplinary expert group, 73 failure modes in the HHVA process were identified and evaluated, from which 15 high-risk failure modes were identified, covering key links such as team formation, data collection, risk assessment and plan formulation. According to the risk priority number, the improvement plan was proposed, such as improving the team structure, establishing a standardized evaluation system, strengthening the training and drill mechanism. This article will share the above experience of HHVA process optimization based on FMEA. FMEA method can effectively identify and quantify the weak links in the HHVA process, and provide theoretical basis and practical guidance for improving the hospital’s disaster emergency response ability and process toughness.
Objective To investigate the application progress of postoperative fluid administration in colorectal surgery. MethodsLiteratures about the advancement of fluid administration in colorectal surgery were reviewed and analyzed. Results Compared to standard fluid management, restrictive fluid administration could reduce the incidence of complications, the length of stay in hospital and improve postoperative survival rate. Colloid-crystalloid combined therapy was better than that pure crystal therapy. Conclusion Volume and type of rehydration influence postoperative recovery, which is also considered in “fast track” colorectal surgery.
Objective To compare the short-term outcomes between laparoscopic surgery and open surgery with fast-track (FT) in patients with colorectal cancer. Methods Between February 2008 and August 2008, the clinical data of 177 patients with colorectal cancer were analyzed retrospectively, who were divided into open group (n=122) and laparoscopic group (n=55) by surgery methods. Open group was further divided into FT group (n=66) and traditional group (n=56). Early rehabilitations were studied and compared among three groups. Results ① The baseline characteristics of patients among three groups were no significant differences (Pgt;0.05) exclude operation time. ② In early rehabilitation, the first flatus of patients in both the FT group 〔(3.86±1.01) d〕 and the laparoscopic group 〔(3.78±1.10) d〕 was significantly earlier than that in the traditional group 〔(4.43±1.25) d〕, Plt;0.05. ③ The first oral intaking in the FT group 〔(2.52±1.14) d〕 was earlier than that in the traditional group 〔(3.38±1.43) d〕 and the laparoscopic group 〔(5.04±2.24) d〕, Plt;0.05, while in the traditional group was earlier than that in the laparoscopic group (Plt;0.05). ④ For drainage management, both the FT group and the traditional group were significantly earlier than those in the laparoscopic group (Plt;0.05). ⑤ For postoperative hospital stay, in the FT group 〔(8.33±1.98) d〕 was also much shorter than that in the laparoscopic group 〔(10.55±3.14) d〕 and the traditional group 〔(10.82±3.76) d〕, Plt;0.05. ⑥ For the postoperative complications, there was no significant difference among three groups (Pgt;0.05). Conclusions FT surgery and laparoscopic technique could both enhance recovery of bowel function, and FT could also shorten postoperative hospital stay. However, further studies are needed to develop a better management.
As one of the crucial measures in the action plan for improving health services, day surgery is committed to efficiently integrating medical resources and improving the quality of medical services. Nowadays, public hospitals in China are vigorously promoting the day surgery cases. The normalization of day surgery is also one of the major goals for the Department of Gastroenterology to meet the current medical needs and explore sub-professional development in line with the discipline’s advantages. Taking the current status of day surgery in the Department of Gastroenterology of West China Hospital of Sichuan University as an example, this paper explores and constructs the “Huaxi Model of Day Surgery in the Department of Gastroenterology”, focusing on the management mode, operation process, operation implementation, quality and safety assurance of day surgery, so as to facilitate the exchange of experiences.