The medical staff in the operation center are performing the first day of operation.
Daytime surgery is an internationally accepted surgical mode. It's not an outpatient operation, it's an inpatient operation, but it only takes 24 hours from operation to discharge. Is such a short and fast operation safe and secure? Can you recover after the operation? After the hospitalization period is shortened, can the problem of hard to find a bed in a big hospital be alleviated? What obstacles have you encountered in promoting this brand-new surgical model? Starting today, we will launch a special report on "Exploring Day Surgery", hoping to help you understand day surgery in all directions.
Can the cost be reduced?
From the perspective of health economics, daytime surgery is mainly to reduce the indirect economic burden of patients, including not only the expenses incurred by family members, but also the waiting cost of patients.
"If the postoperative observation is normal, you can leave the hospital and go home that night." Wu Weidong, a patient in Chengdu, Sichuan, was lying in a hospital bed, receiving infusion and waiting for surgery. He is a little puzzled: how did he get out of the hospital so soon? His wife sat beside him, constantly comforting him. I suddenly had a severe abdominal pain two days ago and went to Huaxi Hospital for emergency treatment. He was diagnosed with acute cholecystitis and needed surgery. After the doctor's evaluation, Wu Weidong meets the standard for day surgery.
"The first operation has started at 9 o'clock, and it will be his turn soon." Head nurse Dai Yan told reporters. The surgeon drew three red forks on Wu Weidong's abdomen, which is the location of laparoscopic cholecystectomy. About a quarter of an hour later, Wu Weidong was pushed into the operating room.
Laparoscopic cholecystectomy is a common surgical operation. Traditional surgery usually requires hospitalization for 5 days and costs about 9000 yuan, while daytime surgery only requires hospitalization for one day and costs about 7000 yuan. After the operation, Wu Weidong recovered at home, and the doctor followed him up regularly by phone for a week. Wu Weidong thinks this kind of operation is good, the hospitalization time is short, and it is more comfortable at home than in the hospital.
"A hospital is by no means the best place for patients to recover." Wen Daxiang, deputy director of Shanghai Day Surgery Management Committee and vice president of Renji Hospital, said that with the development of anesthesia and minimally invasive technology, the trauma of surgery to patients is getting smaller and smaller, and the hospitalization time is shortened accordingly. Normalized family environment can not only reduce the risk of cross-infection, but also be conducive to physical and mental rehabilitation.
"From the perspective of health economics, day surgery is mainly to reduce the indirect economic burden of patients." Zhao Rong, Chairman of Shanghai Day Surgery Management Committee and Director of Shenkang Medical Department, explained that the indirect economic burden of the disease includes not only various expenses incurred by accompanying family members, but also the waiting cost of patients. Especially in the first-tier cities like Shanghai, the biggest role of day surgery is to improve the accessibility of medical services. The Development Center of Shenkang Hospital found that the average total medical expenses decreased 17.5438+0% compared with the same period in the past.
Zhang Zhenzhong, chairman of China Day Surgery Cooperation Alliance, said that day surgery refers to the operation in which patients can enter and leave the hospital within 24 hours. Daytime surgery does not belong to outpatient surgery, and the longest hospitalization time for special patients who need to be postponed due to illness should not exceed 48 hours.
Day surgery originated in developed countries in Europe and America, and gradually matured after 200 1 entered China. From 2065438 to March 2002, the Health Development Research Center of the National Health and Family Planning Commission took the lead in organizing Shen Kang Hospital Development Center in Shanghai, Huaxi Hospital, Beijing Tongren Hospital, Wuhan Women and Children Health Care Center, Xiangya Hospital of Central South University, Shanghai First People's Hospital, Shanghai Renji Hospital and other units to establish the China Day Surgery Cooperation Alliance. 2065438+On May 6, 2005, the National Health and Family Planning Commission and state administration of traditional chinese medicine issued the Notice on Printing and Distributing the Action Plan for Further Improving Medical Services, specifically proposing to "carry out day surgery". The State Council General Office's Key Tasks of Deepening the Reform of Medical and Health System 20 17 proposes to organize a pilot day operation in tertiary hospitals.
Is it safe to leave the hospital on the same day?
If patients have serious complications during or after the operation, they will be transferred to specialized wards for further treatment through the green channel. After discharge, if there are serious complications, patients can be admitted to hospital directly from the green channel.
Laparoscopic total hysterectomy can be regarded as a major operation in gynecological minimally invasive surgery. Usually patients need to be hospitalized for about 5 to 7 days. Now, Yan Chai Hospital has turned it into a day operation, and all routine preoperative tests and anesthesiology visits are completed in the outpatient department. Ms. Zeng suffered from uterine fibroids for several years. She went through the hospitalization formalities in the hospital day operation center and was discharged home on the same day. From 2065438 to September 2005, the gynecology department of Renji Hospital extended the "daytime mode" to laparoscopic hysterectomy and laparoscopic myomectomy, which can be described as "a clever woman can't cook without rice".
However, it is not easy for patients to accept the concept of day surgery. Ma Hongsheng, director of the Day Surgery Center of Huaxi Hospital, recalled that in June 2009, when the day surgery in the hospital was just started, * * * set up 24 beds and 6 independent operating rooms. For safety reasons, patients do not buy it. There are so many wards, only about 10 patients every day.
With the development of minimally invasive surgery and the maturity of anesthesia and anesthesia resuscitation technology, daytime surgery is rapidly popularized. Patients never accept it with confidence. Zhang Zhenzhong said that compared with traditional large hospitals, medical institutions that carry out daytime surgery generally have more detailed preoperative evaluation procedures, more advanced operating room conditions and equipment, more professional and experienced surgeons and anesthesiologists, more scientific diagnosis and treatment procedures, and more perfect postoperative follow-up system.
What kind of patients can receive day surgery? Which doctors can do daytime surgery? The Day Surgery Center of Huaxi Hospital has formulated a set of complete medical quality and safety guarantee measures for day surgery, including the admission standards for doctors, patients and surgical procedures, the evaluation standards for anesthesia before admission, discharge and discharge from resuscitation room, emergency plans during and after hospitalization and follow-up plans after discharge. Huaxi Hospital stipulates that patients with serious complications during or after operation should be transferred to specialized wards for further treatment through the green channel; Discharge assessment can not meet the corresponding standards, transferred to the corresponding ward or arranged by the community health service institutions for hospitalization; If there are serious complications after discharge, you can contact the follow-up personnel of the day operation center through the follow-up phone and be admitted directly from the green channel.
How safe is daytime surgery? According to the clinical statistics provided by Liu Yang, a doctor in the day operation center of West China Hospital, there were 1623 patients undergoing laparoscopic cholecystectomy during the day from March 20 14 to February 20 16, and all patients were followed up by telephone on the 1, 2, 3 and 30 days after discharge. The results showed that there were 3 1 1 case, and the incidence was 19. 16%, in which the incidence of anesthesia was 18.3%, the incidence of postoperative complications was 0.86%, and the overall satisfaction rate of patients was 99.63.
"Short and quick" day surgery is favored by more and more hospitals. So, which diseases are suitable for daytime surgery? Zhang Zhenzhong said that on the basis of previous research, China Day Surgery Cooperation Alliance officially launched 56 kinds of diseases suitable for day surgery, covering 9 disciplines including gastroenterology, orthopedics and ophthalmology. The alliance will further introduce relevant surgical norms and standards through expert argumentation.
"Nothing is more important than the quality and safety of surgery." Zhang Zhenzhong believes that hospitals that join the day surgery alliance must have independent day surgery centers, and the amount of surgery should not be less than 5% of the total number of elective operations, so as to ensure the quality and safety of day surgery.
Can hospitalization be alleviated?
The average length of stay in large hospitals in China is 8-9 days, and that in the United States is 4-5 days. The difference lies in daytime surgery. Carrying out daytime surgery can not only shorten the hospitalization time of patients, but also accelerate the bed turnover rate of hospitals, which is a win-win road for doctors and patients.
Cao glaucoma in Jiaozuo, Henan needs surgery. After the examination in a well-known eye hospital in Beijing, the hospitalization list issued by the doctor was arranged three months later. Cao is a little worried, and his situation waits for no one. Does it take so long to consume energy? The doctor said that there were too many patients in hospital, and there were really no beds. Go home and wait for the call.
It has become a common phenomenon that it is hard to find a bed in a big hospital. Carrying out day surgery can not only shorten the hospitalization time of patients, but also accelerate the bed turnover rate of hospitals, which is a win-win way for doctors and patients.
Jiao Yahui, deputy director of the Medical Administration and Hospital Authority of the National Health and Family Planning Commission, said that simple operations such as appendicitis and inguinal hernia occupy limited hospital bed resources for an average of seven or eight days. If you put it into the day operation center, you can save a lot of beds and let the tertiary hospitals concentrate on treating difficult and serious patients.
Experts pointed out that the number of beds in Peking Union Medical College Hospital, Huaxi Hospital and PLA General Hospital is more than 2,000, while the number of beds in large hospitals in the United States is generally around 1 1,000. In addition to demographic factors, the average length of stay in large hospitals in China is 8-9 days, while that in the United States is 4-5 days. The difference lies in daytime surgery. Daytime operation mode has developed rapidly in Europe and America and has become the main mode of operation. At present, day surgery accounts for more than 60% of elective surgery in many countries, and even as high as 70% and 80% in Britain and America. By the end of 20 16, more than 2,000 medical institutions in China had carried out day surgery, and the proportion of day surgery in elective surgery was only 1 1%.
The Outline of National Medical and Health Service System Planning (20 15-2020) requires that the number of beds in provincial and above general hospitals is about 1000, and in principle it should not exceed 1500; The size of beds in specialized hospitals should also be strictly controlled according to actual needs. The state prohibits the blind expansion of hospitals, which will promote the development of day surgery at the policy level.
"Day care mode is an important means to improve medical services. Hospitals can realize the structural adjustment of hospital supply without expanding beds. " Zhang Zhenzhong said that the development of daytime medical care model must focus on patients' needs, continuously expand the effective supply of medical services, improve the process and quality of medical services in detail, and enhance people's sense of access to medical treatment.
The statistics of Shanghai Renji Hospital are very convincing. In 20 16, the hospital completed more than 30,000 day operations, accounting for more than 40% of the total number of operations in the hospital, and the average length of stay was 1. 12 days, while the average length of stay for patients without day operations was 9. 16 days. With the improvement of resource utilization efficiency, Yan Chai Hospital ranks first in Shanghai in the number of discharged operations with 1.400 beds.
Jiao Yahui said that day surgery is the reengineering and optimization of clinical operation process, which can make full use of hospital bed resources, and has the characteristics of high efficiency, convenient process, short hospitalization time and low cost, which is in line with the development direction of modern hospital management. Vigorously promoting day surgery is an important measure for public hospitals to improve services, improve quality and control costs.