| Objective:In recent years,quite a number of patients are injured by unnecessary defaults and avoidable mistakes in surgery or treatments.Those mistakes which are caused by careless and inadvertent negligence in the course of treatment can sometimes even lead to more severe consequences as a large scale mass injury incident.All those increase the public's concern nowadays about patients' safety issues.Medical safety management becomes the fundamental and core of the survival of medical institutions.It can reflect the rationality of hospitals management process;it also can check the perfective design of the hospitals` risk control system.Above all medical safety management indexes,the quality and safety control of surgical operations is the most important.It is the crux to reflect differences of therapeutic capacity of all medical institutions.The purpose of this research is to investigate rationalization designs of surgical safety evaluation system of a Grade-A Tertiary Hospital using type and amount of complications data obtained from a given level A tertiary hospital.More specifically,by comprehensively analyzing survey data drawn from Surgical Management System,Anesthesia Management System,Nursing Management System and Information Regulatory System,surgical team and the hospital safety supervisor are possible to keep abreast of patients' condition and take appropriate and prompt interventions if necessary to reduce and limit the occurrence of complications in surgical procedures,increase the quality of Medicare services and benefit all surgical patients.Methods:This study selected all available 11603 cases in the first half of 2015 as the baseline cases.All included cases should satisfy the following three criteria:first,patients must age 14 years or older;second,type of anesthesia in surgery can only be intraspinal anesthesia or general anesthesia;third,patients are non-daytime surgical patients.For each case,the study collect five types of data:first the patient's general demographic data,including the patient's gender,age,height,weight and etc.;second history of disease,including whether the patients had detected pathogenic disease,deficiency disease,physiological disease,pulmonary disease,also if the patient has a known drug allergy history;the third type of data are indicators from the preoperative examinations,including blood type,serological indexes,routine urine test indicators,etc;fourth type of data covers surgical operation information,including methods of operation,level of the surgery etc.;the final source of data collected in the study are types of complications or side effects.All surgical departments are then divided into three categories according to the severity of postoperative complications:low,moderate and high complication departments.Low complications department includes Breast Surgery,clinical Gynecology,and Otolaryngology department;moderate complications department are clinical Obstetrics,Sports Medicine Joint Surgery;and high complication departments include Thoracic Surgery,Neurosurgery,Cardiac Surgery,Gastrointestinal Surgery,Liver and Gallbladder Surgery,Anorectic Surgery,Gastrointestinal tumor Surgery,Thyroid Surgery,Burns surgery,Vascular Surgery,Pancreaticobiliary surgery,orthopedics and Urological Surgery department.In order to be able to intervene timely and precisely,the critical departments were again classified into low,medium and high operation risk groups following the ASA physical status classification system and the operation grading system in China.Interventions were provided to patients depending on the risk factors,the perioperative medical quality control management,nursing management and surgical anesthesia safety management.Statistical analysis was performed on the relevant data using chi-square test and logistic regression.Results : 1.Results indicated that the number of hospitalization days,body temperature,and admission into ICU,postoperative blood transfusion,white blood cell count and gender had effects on postoperative complications.In addition,the number of hospitalization days,body temperature,admission into ICU,postoperative blood transfusion and white blood cell count were risk factors;the incidence of postoperative complications was higher in men than which in women.2.According to the data for the first half of 2015,the number of hospital days(P<0.001,OR=0.917)was a risk factor for postoperative complications in Urological Surgery.For Neurosurgery patients,admission into ICU,anamnesis,postoperative blood transfusion,white blood cell counts and hemoglobin had significant effects on postoperative complications.Admission into ICU,anamnesis,postoperative blood transfusion and white blood cell counts were the risk factors of postoperative complications.Hemoglobin was a protective factor.In Gastrointestinal Surgery,hospitalization days more than 20 and admission into ICU were risk factors for postoperative complications.3.After the intervention,the results showed that postoperative complications,white blood cell grouping,body temperature,postoperative blood transfusion,etc.(P<0.05)decreased significantly.The number of complications in the first half of 2016(565 cases)was lower than the number of complications in the first half of 2015(894 cases),and the number of operations in 2016(15084 cases)was higher than that in the first half of 2015(11603 cases).The number of complications in the first half year of 2016(3.75%)was significantly lower than the complications in the first half of 2015(7.70%)Conclusion:1.The rationality of the medical procedures and the standards of the medical staffs` diagnosis and treatment process are the key to ensure the reduction of postoperative complications.The rational design of standardized treatment procedures and the operation process of medical staff are the top priorities of all medical institutions and hospital management supervisors.Through this study,it is possible to reduce the incidence of complications by controlling risk factors such as hospitalization days,body temperature,admission into ICU,postoperative blood transfusion,and white blood cell counts.2.For each clinical surgical department,the management of complications should be carried out according to the situation and the unique characteristics of these departments.The management of hospitalization days for Urological Surgery should be carried out to reduce the occurrence of postoperative complications.Medical staffs in Neurosurgery should to prevent the occurrence of complications according to admission into ICU,anamnesis,postoperative blood transfusion,white blood cell counts and hemoglobin.Medical staffs in the department of Gastrointestinal Surgery according to the patient's the number of hospitalization days,admission into ICU to reduce the incidence of complications3.Through surgical safety control measures,the medical behavior of medical staffs could be partially corrected.Interventions could effectively reduce white blood cells,body temperature,postoperative blood transfusion,and reduce the incidence of postoperative complications.The intervention program was effective,but more efforts should be implemented to further reduce the number of postoperative complications. |
PDF Full Text Request