Chapter I General Provisions

Article 1 This standard system is formulated to strengthen the management of clinical application of surgical techniques in hospitals, ensure medical safety, improve medical quality, and strengthen the operation management of various surgical departments and doctors.

Article 2 This Code is formulated in accordance with the Regulations on the Administration of Medical Institutions, the Law of People's Republic of China (PRC) Municipality on Medical Practitioners, the Regulations on the Handling of Medical Accidents and the Tort Liability Law, combined with the actual situation of our hospital.

Article 3 This specification is applicable to all clinical operation departments in the hospital.

Chapter II Classification of Clinical Surgery

Article 4 Surgery and invasive surgery refer to all kinds of open surgery, endoscopic surgery and interventional therapy (hereinafter referred to as surgery). According to its technical difficulty, complexity and risk level, the operation is divided into four levels:?

One kind of operation: common minor operation, simple operation process and low technical difficulty.

Second-class operations: all kinds of medium-sized operations, the operation process is not complicated, and the technical difficulty is not great;

Three types of operations: all kinds of major operations with complicated surgical procedures and difficult surgical techniques;

Four types of operations: all kinds of operations with complex surgical procedures and difficult surgical techniques. ?

Chapter III Classification of Surgeons

Article 5 All surgeons shall obtain the qualification of medical practitioners according to law, and their practice place shall be in our hospital. According to their health technical qualifications and corresponding positions, the classification of surgeons is stipulated.

(1) residents

1. Junior resident: those who have worked as residents for less than 3 years, or those who have worked as residents for less than 2 years after graduation.

2. Senior resident: worked as a resident for more than 3 years, or graduated from a master's degree and obtained the qualification of a medical practitioner, and worked as a resident for more than 2 years.

(2) Attending physician

1, primary attending physician: those who have served as attending physician for less than 3 years.

2. Senior attending physician: one who has served as attending physician for more than 3 years.

(3) Deputy Chief Physician

1, junior deputy chief physician: less than 3 years as deputy chief physician.

2. Senior deputy chief physician: one who has served as deputy chief physician for more than 3 years.

(4) Chief physician

Chapter IV Classification and Admission of Surgeons

Article 6 All surgeons shall be qualified as medical practitioners according to law, and their practice place shall be in our hospital.

1. Resident: Under the guidance of superior doctors, gradually develop and master the first-class operation.

2. Attending physician: master the first and second types of surgery, and gradually carry out the third type of surgery under the guidance of superior doctors.

3. Junior deputy chief physician: master the first, second and third types of surgery, and gradually carry out four types of surgery under the guidance of superior doctors.

4. Senior Deputy Chief Physician: Skillfully complete the first, second and third types of operations, and perform four types of operations under the guidance of the chief physician. You can also independently complete some four types of operations and carry out new operations according to the actual situation.

5. Chief physician: proficient in all kinds of operations, especially to carry out new operations or introduce new operations, or major exploratory scientific research projects.

Seventh according to the surgeon engaged in professional, surgical qualifications and practical skills and other factors to determine. , it should be clear that the surgeon can preside over the operation project and implement dynamic management.

1. Qualification access: Doctors at all levels can obtain the corresponding surgical qualification access if they meet the following conditions in the corresponding surgical classification with declared qualifications: the number of cases completed with one-time assistance >15; As an operator, the number of cases completed under the guidance of superior doctors is more than 5 cases; There are no serious complications and medical disputes in this kind of operation and treatment; Ward and department passed the two-level appraisal.

2. disqualification: if there are two or more serious complications or medical disputes in the same operation within one year, the operation qualification will be disqualified.

3. Those who are disqualified, as operators, have completed more than 5 cases under the guidance of superior doctors; When there are no serious complications and medical disputes in the operation and treatment of this kind of operation, it is qualified again after evaluation.

Chapter V Operation Approval Authority

Eighth operation examination and approval authority refers to the examination and approval authority for all kinds of operations, which is the key to control the quality of operations.

(1) Normal elective surgery

1. General operation: In principle, the operation shall be discussed by the department and approved by the department director or the deputy director authorized by the department director.

2. Four types of operations: approved by the director, the operation notice is issued by the senior deputy chief physician and above, and reported to the medical department for the record. Under special circumstances, the major and disabling surgery approval form must be filled in, and the director of the department will report it to the medical department after signing the opinions according to the discussion of the department, and it will be implemented after being approved by the hospital leaders.

3, to carry out major exploratory, scientific research, clinical access management of medical institutions, surgical projects, should be reported to the superior health department for examination and approval in accordance with the provisions, major projects involving life safety and social environment should also be reported to the relevant state departments for examination and approval in accordance with the provisions.

(2) Special surgery

Any of the following operations can be regarded as special operations:

(1) Surgery may lead to disfigurement or disability;

(2) The same patient needs reoperation due to complications;

(3) high-risk surgery;

(4) the new operation of this unit;

(5) Surgery that may cause or involve medical disputes;

(6) The surgical patients are foreign guests, overseas Chinese, compatriots from Hong Kong, Macao and Taiwan, and special people.

(7) Doctors from other hospitals who come to the hospital to participate in surgery and practice medicine in different places must go through relevant procedures in accordance with the relevant provisions of the Law of People's Republic of China (PRC) on Medical Practitioners.

Any of the above cases can be regarded as a special operation. Before the operation, it must be seriously discussed by the department, signed by the department director and reported to the medical department for the record. If necessary, it can be consulted in the hospital or reported to the leaders of the competent hospital for approval. Medical practitioners, foreign units and medical operations in different places need to go through relevant examination and approval procedures in accordance with the requirements of the Medical Practitioners Law. The practice procedures of foreign doctors shall be examined and approved according to the relevant provisions of the state.

In addition, in an emergency or emergency, in order to save the patient's life, the attending physician should make decisive decisions, race against time to actively rescue, and report to the superior physician and the chief duty in time, and shall not delay the rescue opportunity.

Chapter VI Operation Process Management Specification

Article 9. All patients who need hospitalization surgery should do a good job of preoperative examination, make a clear diagnosis, and choose the indications before deciding on surgery. All departments should strictly follow the operation scope of doctors at all levels and arrange the operation personnel reasonably.

Article 10 Before the operation, the doctor in charge shall fill in the informed consent form for the operation, and the patient shall fill in the power of attorney, which can be signed by the client. When the patient is critically ill and in urgent need of surgery, but has no capacity for behavior and his family members are absent, the department or emergency doctor on duty shall report to the medical education department (medical department) or the chief duty officer, and the operation can only be carried out after approval, but it must be recorded in detail in the medical record for future reference.

Eleventh before any operation in the hospital, the competent physician should write a preoperative summary or preoperative discussion, and the superior physician should read it and sign it.

Twelfth major, difficult, complex surgery, disability surgery and new surgery, should take a cautious attitude, fill in the declaration form of special surgery and report it to the medical department, and it can be implemented only after it is approved by the hospital leaders. This kind of operation must be discussed before operation, presided over by the director or the director (deputy) doctor, and attended by the surgeon, anesthesiologist, head nurse and relevant personnel. The discussion content shall be recorded in the medical record by the responsible physician and reported to the medical department, and the medical department shall send people to participate in the preoperative discussion when necessary.

Thirteenth elective surgery should be performed 1 day before surgery, and the attending physician should fill in the operation notice, and then send it to the operating room after being signed by the department director or the director (deputy) physician, and the operation room will arrange the operation.

Fourteenth emergency surgery should be filled out by the attending physician and sent to the operating room after being signed by the superior surgeon. The operating room or anesthesiology department should actively cooperate with emergency surgery, and must not make things difficult, shirk or refuse without reason.

Fifteenth preoperative anesthesiologists must examine patients, such as preoperative preparation does not meet the requirements of anesthesia, anesthesiologists have the right to decide to postpone the operation.

Sixteenth doctors at all levels should operate in strict accordance with the scope of operation of doctors at all levels.

Seventeenth advanced doctors and students to participate in the operation, must have our doctors to participate in and be responsible for the guidance, any problems in the operation, shall be the responsibility of our doctors.

Eighteenth surgical participants should strictly implement the provisions of the operating room, and carefully check the patient's name, gender, bed number, diagnosis and surgical site before operation. The head nurse has the right to stop the operation of medical personnel who violate the system and do not operate according to aseptic technology, and investigate personal responsibility according to the circumstances and consequences.

Nineteenth in the operation, the operator and assistant should cooperate closely. Participants in the operation should be highly responsible for the patient during the operation and should not talk about topics unrelated to the operation. In the patient's nervous state, the medical protection system should be strictly implemented. During the consultation on the stage, relevant personnel should be on call. In case of any accident, the medical staff on and off the stage should take active measures, and the surgeon is responsible for organizing the rescue, and request the superior doctor or report to the relevant leaders for assistance as appropriate. If the surgeon or assistant has an accident (such as fainting) during the operation, the person with the highest professional title present will decide to replace the personnel or start the emergency replacement procedure.

Twentieth strictly implement the check system to prevent errors and accidents. Before suture, the operator and assistant should carefully check whether there is active bleeding and foreign body residue in the operation field. After the operation, it is necessary to conduct a comprehensive and strict examination of the patient's general situation and operation.

Twenty-first patients after surgery, if the condition permits, by the operating room nurses, responsible doctors back to the ward, general anesthesia or critical patients and anesthesiologists or surgeons think it is necessary to patients, anesthesiologists should accompany back to the ward. The surgeon should make a good postoperative doctor's order and explain the matters needing attention to the ward attendant.

Twenty-second before the operation, the anesthesiology department should consult and fill in the anesthesia talk list, which should be signed by the patient himself. If the patient fills in the power of attorney, it can be signed by the client. After the operation, the anesthesiologist should explain the operation, anesthesia process and precautions with the ward doctors and nurses before sending the patient back to the ward, and measure blood pressure, pulse and breathing face to face.

Attached is the classification table of clinical professional surgery:

First, the surgical system

Four types of operations

1 general surgery

(1) Total gastrectomy and extended radical gastrectomy for gastric cancer;

(2) Left and right hemihepatectomy, left lateral lobectomy and wedge resection;

(3) Radical resection of pancreatic cancer and extended pancreatoduodenectomy;

(4) reoperation of biliary tract;

(5) Abdominal aortic aneurysm resection and transplantation;

(6) Fetal pancreas transplantation with blood vessels;

(7) Thoracocervical resection of tumor of innominate artery and subclavian artery and vascular transplantation;

(8) Extended total pancreatectomy;

(9) Cervical lymph node dissection and parathyroidectomy for thyroid cancer;

(10) right atrial appendage inferior vena cava bypass grafting;

(1 1) Abdominal tumor with more than three kinds of organ resection;

(12) various new operations;

(13) Exploration of unclear diagnosis.

2. Cardiothoracic surgery

(l) Method 4 and Method 3 orthodontics;

(2) Repair of atrioventricular defect with pulmonary hypertension;

(3) coarctation of aorta and vascular reconstruction of abdominal aortic aneurysm;

(4) cardiac multi-valve replacement and plasty;

(5) coronary artery bypass grafting;

(6) complex intracardiac malformation correction and short circuit surgery;

(7) aortic aneurysm resection;

(8) mediastinal tumor resection;

(9) new business;

(10) Exploration of unclear diagnosis.

3. Neurosurgery

(1) The supratentorial and infratentorial approaches were used to remove various tumors;

(2) clipping various aneurysms via supratentorial and infratentorial approaches;

(3) Resection of abnormal blood vessels via supratentorial and infratentorial approaches;

(4) Autologous (allogenic) adrenal medulla or substantia nigra transplantation in the brain;

(5) new operation.

4. Urology

(1) all kinds of renal vascular replantation and plastic surgery;

(2) Laparoscopic ureter, kidney and adrenal surgery;

(3) Partial nephrectomy caused by various reasons;

(4) Renal tumor enucleation and radical nephrectomy;

(5) Percutaneous nephrolithotomy;

(6) Exploration with unclear diagnosis;

(7) Various enterobladder replacement operations;

(8) Radical prostatectomy.

5. Burn plastic surgery

(1) fenestration with allogenic skin and autologous skin implantation;

(2) vascular transplantation and skin flap coverage;

(3) Vascular anastomosis, free skin flap transplantation and allogenic omentum transplantation;

(4) venous reticular skin island;

(5) Micro-transplantation of autologous skin and large-area allogenic skin mixed transplantation;

(6) new business;

(7) Exploration with unclear diagnosis.

6. Orthopedics and Traumatology

(1) Total joint replacement;

(2) finger (toe) reconstruction with vascular pedicle;

(3) replantation of severed limbs (fingers and toes).

Three operations

1 general surgery

(1) Various operations on liver, gallbladder, pancreas and spleen except four types of operations;

(2) stomach and duodenum operation and gastrointestinal anastomosis;

(3) Treatment of liver and spleen injury;

(4) Rectal resection and ileocecal resection;

(5) colostomy and radical resection of colon cancer;

(6) Various thyroid and parathyroid operations other than the four types of operations;

(7) radical mastectomy;

(8) Various shunts and devascularization for portal hypertension;

(9) Radical operation of various segments of intestinal cancer;

(10) Abdominal exploration.

2. Cardiothoracic surgery

(1) partial pericardiectomy;

(2) Repair of atrial septal defect;

(3) single heart valve replacement, dilation, separation and plasty;

(4) operation of patent ductus arteriosus;

(5) Angiographic diagnosis of the heart;

(6) pneumonectomy and lobectomy;

(7) Pleurectomy;

(8) mediastinal surgery except the four categories;

(9) tracheobronchial plasty;

(10) Implantation of artificial cardiac pacemaker;

(1 1) artificial blood vessel transplantation;

(12) neck and upper thoracic esophageal cancer resection;

(13) neck hemangioma resection;

(14) replacing esophagus with colon;

(15) There are four types of chest exploration.

3. Neurosurgery

(1) Various intracranial operations except four;

(2) Various operations inside and outside the spinal canal;

(3) All kinds of nerve anastomosis;

(4) Open brain injury clearance;

(5) various skull operations;

(6) decompression, drainage and aspiration of various skull drilling;

(7) Total cerebral angiography with femoral artery intubation;

(8) Transcranial artery puncture cerebral angiography.

4. Urology

(1) Kidney surgery except four types;

(2) Ureteroscopic surgery for upper and middle ureteral calculi or ureteral strictures and polyps;

(3) Transurethral resection of bladder tumor;

(4) all kinds of repair and plastic surgery of urinary system;

(5) Suprapubic prostatectomy or transurethral prostatectomy;

5. Burn plastic surgery

(1) Prefabrication of vascular graft flap;

(2) escharectomy and skin grafting;

(3) skin flap transplantation;

(4) skin tube plasty;

(5) Free myocutaneous flap transplantation.

6. Orthopedics and Traumatology

(1) Spinal plasty;

(2) Management of severe traumatic systemic syndrome;

(3) arthrodesis;

(4) Congenital medullary dislocation;

(5) Amputation (fingers and toes) and meniscectomy;

(6) bone tumor resection;

(7) excision of bone wart;

(8) Fixing and pulling the three-wing nail;

(9) Internal fixation of limbs, bone grafting and steel plate removal;

(10) Various joint operations;

(1 1) Open fracture expansion reduction;

(12) Repair with skin tube plasty.

Secondary operation

1 general surgery

(1) Incision and drainage of liver abscess;

(2) enterotomy;

(3) exploratory laparotomy for abdominal injury;

(4) Repair of gastrointestinal perforation;

(5) Gastrointestinal anastomosis;

(6) Ligation, bridging and resection of great saphenous vein;

(7) Simple cholecystostomy;

(8) Simple mastectomy.

2. Cardiothoracic surgery

(1) resection of benign tumor of chest wall soft tissue;

(2) Closed thoracic drainage;

(3) Open drainage of empyema;

(4) Thoracic tuberculosis focus clearance.

3. Neurosurgery

(1) Debridement and suture of various complicated scalp injuries;

(2) excision of various scalp tumors;

(3) excision of various exostoses;

(4) Chemotherapy via arterial puncture.

4. Urology

(1) Simple urethrotomy;

(2) High ligation of hydrocele of spermatic cord and inversion of testis and tunica vaginalis;

(3) High ligation of varicocele;

(4) cryptorchidism;

(5) Simple lower ureteral calculi were treated with ureteroscopic lithotripsy and internal drainage;

(6) Transurethral lithotripsy of bladder stones;

(7) Suprapubic cystostomy.

5. Orthopedic surgery

(1) Muscle transposition and calcaneal lengthening;

(2) excision of hand sheath cyst;

(3) correction of thumb valgus;

(4) Closed fracture reduction and fixation;

(5) clearing the focus of low toxic bone abscess;

(6) Bone traction

A kind of operation

Length general surgery

(1) one-stage appendectomy;

(2) Primary hernia repair;

(3) removing body surface tumors and foreign bodies;

(4) hemorrhoid core and hemorrhoid fistula surgery;

(5) Incision and drainage of body surface abscess

2. Cardiothoracic surgery

(1) Incision and decompression of mediastinal emphysema;

(2) Debridement and suture of chest wall wound.

3. Neurosurgery

(1) suture of mild scalp trauma.

4. Urology

(1) Simple circumcision and wound suture;

(2) Simple excision of scrotum, urethral orifice and perineum;

(3) Simple urethral dilatation.

5. Orthopedics and Traumatology

(1) Manual reduction of facet dislocation;

(2) Incision and drainage of facet joint cavity.

Second, the obstetrics and gynecology system

Four types of operations

(1) radical hysterectomy for uterine cancer;

(2) Radical operation of ovarian cancer;

(3) Repair of complex urinary leakage;

(4) Radical operation of vulvar cancer;

(5) Various difficult vaginal operations;

(6) All kinds of artificial vaginoplasty;

(7) Various complicated operations for dystocia;

(8) new business;

(9) Exploration with unknown diagnosis.

Three operations

(1) Uterine and cervical surgery except four categories;

(2) moving, shaping and removing accessories other than the four categories;

(3) extensive excision of vulva;

(4) Simple vaginal urethroplasty and simple vulva excision;

(5) Fetal fragmentation and craniotomy;

(6) Extraperitoneal cesarean section;

(7) Broad ligament surgery;

(8)T-degree perineal laceration suture.

Secondary operation

(1) Accessory surgery except four types;

(2) vulvar surgery except four types;

(3) classic cesarean section and lower uterine section;

(4) ectopic pregnancy surgery;

(5) suture the second perineal laceration.

A kind of operation

(1) Cervical biopsy;

(2) ring, ring removal and induced abortion;

(3) fetal head aspiration;

(4) taking placenta artificially;

(5) Hip traction;

(6) Incision of papillary cyst;

(7) Hymen incision;

(8) Suture of perineal laceration below the second degree;

(9) lateral episiotomy;

(10) Various electrocoagulation.

Third, ophthalmic surgery.

Four types of operations

(1) optical corneal transplantation;

(2) Removal of deep orbital foreign bodies;

(3) Vitrectomy;

(4) intraocular lens implantation;

(5) Intraorbital tumor resection;

(6) Orbital puncture;

(7) Complex retinal detachment;

(8) New operation.

Three operations

(1) ocular alkali reconstruction;

(2) Extracapsular cataract extraction;

(3) radial lamellar keratotomy;

(4) eye muscle surgery;

(5) glaucoma and cataract surgery;

(6) Orbitoplasty;

(7) eye risk plastic surgery;

(8) Vitrectomy;

(9) crystal surgery except for the four categories;

(10) Orbital surgery except for four types;

(1 1) Greater omentum surgery except four types;

(12) Ophthalmic surgery except four categories;

Dacryocystorhinostomy.

Secondary operation

(1) Ophthalmic alkali surgery except the third category;

(2) Conjunctival and corneal surgery except for three types;

(3) Simple eye injury (suture and foreign body removal).

Otolaryngology system

Four types of operations

(1) Radical laryngectomy;

(2) Hemilaryngectomy and pronunciation reconstruction;

(3) Laryngoplasty;

(4) rhinoplasty;

(5) Inner ear surgery;

(6) Radical mastoidectomy;

(7) craniotomy to remove huge frontal sinus tumor;

(8) Nasopharyngeal cancer surgery.

Three operations

(1) Maxillary resection;

(2) removing foreign bodies from trachea and esophagus;

(3) Laryngeal surgery except four types;

(4) myringoplasty;

(5) facial nerve decompression;

(6) Repair of external auditory canal stenosis and atresia;

(7) Otoplasty;

(8) Sphenoid sinus and ethmoid sinus surgery;

(9) Nasal septum surgery;

(10) There are four types of mastoid surgery;

(1 1) Radical maxillary sinus surgery

Secondary operation

(1) tonsillectomy (extrusion);

(2) adenoidectomy;

(3) Partial excision of middle and lower turbinates;

(4) turbinate sealing and electrocoagulation.

A kind of operation

(1) Eustachian tube ventilation;

(2) Maxillary sinus puncture;

(3) myringotomy;

(4) Treatment of tonsil abscess.

Verb (abbreviation for verb) Maxillofacial surgery system

Four types of operations

(1) Immediate repair and organ reconstruction of huge tissue defect in maxillofacial region;

(2) cleft lip repair and median cleft repair;

(3) removal of huge facial and maxillofacial neurofibromas;

(4) facial nerve surgery;

(5) repair of salivary gland fistula and catheter anastomosis;

(6) temporomandibular joint arthroplasty;

(7) release mental trauma;

(8) Extended resection of palatal tumor; "

(9) chin plasty;

(10) neck lymph node dissection;

(1 1) maxillary and mandibular anterior sinus correction;

(12) avulsion around trigeminal nerve.

Three operations

(1) cleft palate cyst resection;

(2) Various operations on maxilla and mandible;

(3) cleft palate repair;

(4) submandibular gland removal;

(5) Parotid tumor and parotidectomy;

(6) Maxillofacial tumor resection;

(7) correction of nose and lip deformity;

(8) thyrohyoid cyst resection;

(9) Maxillofacial plastic surgery is divided into four categories;

(10) zygomatic arch fracture reduction;

(1 1) It is difficult to extract impacted teeth;

(12) tooth replantation and transplantation

Secondary operation

(1) oral soft tissue tumor resection;

(2) sublingual gland resection;

(3) Excision of submandibular gland cyst;

(4) Removal of submental and submandibular cysts;

(5) Tongue frenulum surgery;

(6) facial scar repair;

(7) facial nevus surgery;

(8) Maxillary sinus fistula repair;

(9) Cleft palate repair;

(10) Oral and maxillofacial inflammation;

(1 1) alveolar surgery.

A kind of operation

(1) Tooth trauma ligation and intermaxillary fixation;

(2) suture of tongue trauma;

(3) Alveolar process plasty;

(4) Incision of extraoral abscess;

(5) Treatment of maxillofacial soft tissue trauma;

(6) Fixation of simple maxillary and mandibular fractures;

(7) tooth extraction;

(8) Removal of residual roots.