| Objective(1)Based on the pre-hospitalization management mode,combined with the diagnosis and treatment characteristics of daytime operation of intestinal polypectomy,the pre-hospitalization process of daytime operation was improved,and the Delphi expert inquiry method was used to construct the"pre-hospitalization management mode of daytime operation of intestinal polypectomy",which provides reference for improving the daytime operation management system of digestive medicine and promoting the development of hospital daytime operation specialization.(2)A quasi-experimental study was used to verify the impact of the daytime operation pre-hospitalization management mode on the utilization rate of medical resources,the quality and safety of surgery and the sense of medical experience of patients with colorectal polypectomy under colonoscopy.Method(1)On the basis of literature review,we selected a combination of pre-hospitalization mode and daytime surgical service process for items that can be used clinically,a database of expert consultation questionnaire items for screening and consultation should be developed first.Based on literature review,modern research,and clinical operation practices,the Delphi Expert Consultation Questionnaire on the Management Mode of Pre-hospitalization for Day Operation of Intestinal Polyp Resection was developed.Select 20 experts with complementary expertise,reasonable knowledge structure,and geographical representation from multiple provinces and cities across the country.Based on the Delphi expert consultation,two rounds of data statistical analysis were conducted from a qualitative and quantitative perspective to evaluate the enthusiasm and authority of the experts,and the management model for daytime surgery for intestinal polypectomy was modified based on the item importance assignment mean,coefficient of variation,and expert recommendations.Consensus was reached to clarify the content of daytime surgery management model for intestinal polypectomy.(2)Using the similar experimental study,we selected the results of the department of digestive medicine in a city’s third-class A general hospital from May to October 2022.178 patients with intestinal polyps were randomly divided into control group and observation group with 89 patients each.The patients in the control group adopted the routine daytime operation process to implement the routine daytime operation management.The outpatient doctor evaluated the patients and issued an inpatient certificate.The patients went to the daytime ward with the inpatient certificate to reserve a bed.After admission,they received routine perioperative nursing.After discharge,the daytime ward provided telephone follow-up.The patients in the observation group implemented the pre-hospitalization-modified daytime operation management mode based on the control group,and carried out process optimization around the five aspects of pre-hospitalization,admission,surgery,discharge,and continuous nursing,mainly including:pre-hospital management based on pre-hospitalization,virtual bed to complete preoperative examination and anesthesia evaluation;Rapid intestinal preparation for admission;Accurate surgical scheduling;Convenient self-service admission and discharge;Continuous care at home.The utilization rate of medical resources,the quality and safety of surgery,and the sense of medical experience of patients in the two groups were analyzed and compared.Result(1)The effective recovery rates of the two rounds of expert correspondence questionnaires were 95.23%and 100%respectively,with 25 and 7 suggestions for modification proposed.The expert judgment coefficient is 0.905,the familiarity coefficient is 0.910,and the authority coefficient is 0.908.Based on the statistical results and modification suggestions of experts on the description,importance,and feasibility of each item,and after two rounds of expert correspondence,it was finally determined that the management model for pre hospitalization of daytime surgery for intestinal polyps included 5 first level items,18 second level items,and 76third level items.(2)There was no significant difference between the two groups in terms of gender,age,hypertension history,diabetes history,coronary heart disease history,residence,medical payment,marital status and polyp type(P>0.05).(3)In the control group,there were 4 people who missed their appointment on the day of admission,with a missed appointment rate of 4.65%.In the observation group,no one missed their appointment,with a missed appointment rate of 0%.There was a statistically significant difference in the rate of missed appointments on the day of admission(P=0.058).(4)Waiting time for hospitalization in both groups(W=6589.5,P＜0.001).Waiting time for surgery(t=6.701,P＜0.001).Average length of stay(W=7117.5,P＜0.001),the results were statistically significant.(5)The qualified rate of intestinal preparation in the observation group was 89.66%,while the qualified rate of intestinal preparation in the control group was75.58%,with a statistically significant difference(X~2=5.035,P=0.025).The score of intestinal cleanliness in the observation group was superior to that in the control group,with a statistically significant difference(W=2387,P＜0.001).(6)The delayed discharge rate in the observation group was 9.20%,which was statistically significant compared with 22.09%in the control group(X~2=4.527,P=0.033).(7)The satisfaction rate of daytime surgical inpatient service in the observation group was96.55%,higher than that in the control group(84.88%),with a statistically significant difference(P=0.009).Conclusion(1)The research results show that the experts selected in this study are highly representative and authoritative,and can enrich the content of the model from multiple perspectives.The"Pre hospitalization Management Model for Intestinal Polyp Resection Day Surgery",built around improving the utilization rate of medical resources,improving the quality and safety of surgery,and improving the patient’s medical experience,reflects clinical practicality from the perspective of meeting clinical needs.(2)Implementing the daytime surgical pre-hospitalization management mode for patients with intestinal polypectomy can reduce the rate of missed appointments on the day of admission,shorten the waiting hospitalization time,reduce surgical waiting and average hospitalization time,and improve the utilization rate of medical resources.(3)Implementing the pre-hospitalization management mode for daytime surgery for patients with intestinal polyps can improve the qualified rate of intestinal preparation,reduce the occurrence of delayed discharge of patients undergoing daytime surgery,and improve the quality and safety of daytime surgery.(4)Implementing the daytime surgical pre-hospitalization management model for patients with intestinal polypectomy can improve patients’satisfaction with daytime surgical medical care and enhance their sense of medical experience. |
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