| BackgroundChina Health Care Reform has entered the key period in the21st century, and the state’s new medical reform policy clearly asked to insist the properties of the social welfare of the public health. With the gradual deepening of China Health Care Reform, how to make full use of limited health care resources, the difficulties of alleviate mass medical treatment, and the tense of hospital beds have evolved into the focus of the whole society.Management Evaluation Guide (2008Edition), which was issued by the Ministry of Health Hospital in2008, classified the average length of stay as a work efficiency indicator in the evaluation of hospital performance, and asked to take effective measures to shorten the average length of stay in elective surgery patients before surgery. The move has played a catalytic role in shorting the average length of stay and hospital actively and increasing the utilization effective of health resources.The average length of stay is a comprehensive reflection of hospital work efficiency, management level, quality of work, nursing quality, and the cooperation between different departments. Obviously, the influence of the average length of stay on the quality of medical, hospitalization expenses, medical insurance reimbursement and hospital benefit has become a hot topic concerned by hospital managers, medical staff, patients and patient’s families. On the premise of the guarantee of the quality of medical work and efficiency, shortening the average length of stay in hospital can not only effectively reduce the fees of medical treatment and the economic burden for patients, but also extend the capacity of patients in hospital, improving the utilization rate of hospital beds. Thus, we can improve the social benefit and economic benefit of hospital.ObjectivesAt present there are many factors that can influence such confinement to patients, including social factors, patients and hospital internal factors. This topic through the literature research, questionnaire investigation and data analysis, find out factors that influence the hospital surgery patients, on average, such confinement reasonably shortened average such confinement of concrete measures are put forward. Methods1, Through the query, and reading a large number of the literature of such confinement and preoperative such confinement at home and abroad, to find about average such confinement and influence factors of such confinement preoperatively and shorten the average countermeasures of information of such confinement, understand both at home and abroad about the progress of the study of such confinement.2, The use of Powder Builder data extraction tool from the no.1Hospital Information System (Hospital Information System, HIS) extracted from2008-2012,110638cases of surgical patients in the Hospital Information, with the help of statistical analysis software SPSS13.0, about average such confinement surgery department, the main influencing factors of average hospitalization, average such confinement differences before and after the implementation of clinical pathway, orthopedics super-long such confinement conditions such as data analysis process. This study mainly USES the single factor descriptive statistics analysis, nonparametric test, multiple linear regression analysis, t test statistical analysis method, etc.3Interviewed the director of the department of surgery, the effect factors of such confinement for collecting, sorting and induction. Analyze these factors by using fishbone diagram to.4, Detailed reading hospital orthopedics,211cases of more than30days of such confinement the patient’s medical record information, to understand their pathological diagnosis and basic hospitalization duration, and although the doctor understand the related information in hospital.Results1, Hospital average length of stay and preoperative average length of stay has a declined trend from2008to2012, a slight increase in2012. The average length of stay surgery departments ranked the top three departments were neurosurgery, orthopedic and cardiothoracic surgery, neurosurgery, average length of stay daily maximum. Cardiothoracic Surgery and Neurosurgery, average length of stay increased year by year, orthopedic declining trend in average length of stay.2, Through the single factor analysis and nonparametric test analysis and multiple regression analysis, patient age, gender, payment method, occupation, level of curative effect, surgery, preoperative such confinement for surgical patients, on average, such confinement, P<0.001, the difference was statistically significant.3, After the implementation of clinical pathway implementation than before there is a decrease in the average such confinement, P<0.001, the difference was statistically significant.4, Have an impact on the average such confinement of such confinement preoperatively, preoperative such confinement factors including waiting time and waiting time for operation, patients admitted to hospital basic situation, the consciousness of medical staff and so on. 5, Fishbone diagram analysis, the influence of such confinement factors can be divided into six categories:external environment factors, patient factors, factors, hospital operating room management system management, and other factors.6, Hospital surgical department length of stay≥30days of the patients showed an increasing trend year by year from2008to2012. Days in orthopedic and neurological surgery are longest. Super long such confinement in patients with increase of average hospital such confinement in the lower and the improvement of hospital efficiency.ConclusionsFirst, the average hospital surgical department main influence factors of such confinement can be divided into social factors, patients and hospital internal factors.1, Social factors including:the national basic medical insurance system, medical treatment insurance, commercial medical insurance system, new farming and medical insurance system.2, Patients factors including:(1) demographic characteristics and condition. Patient’s age, gender, origin, family conditions on the average hospitalized day has certain influence. Of hospitalized patients admitted in large general hospital for patients with incurable diseases, subject to the accompanying disease, body conditions and factors, such as the economic ability to shrink their average such confinement is relatively difficult.(2) Payment method. Payment method on the average surgical patients is mainly due to the influence of regulations of insurance of primary medical treatment of such confinement in the outpatient clinic medical costs from individual account payment, personal account after use, patients need to be at his own expense, to reimburse clinics, patients with will, using means of hanging bed virtually increased its preoperative hospitalization time.(3) The type of surgery. Super-large surgery in patients with preoperative such confinement is greater than the small and medium-sized surgery in patients with preoperative such confinement. Super-large surgery the patient heavier, inspection items, the surgery doctor’s qualification, surgical instrument disinfection requirements higher, surgical preparation process trivial, these reasons result in catastrophic surgery in patients with preoperative preparation longer than small and medium-sized surgery patients.(4) The wishes of the patients. Ailment big keep patient for personal purposes, hospital after recovery is not willing to, or refuses to go through the discharge formalities, etc.; Patients do have commercial insurance, for reimbursement of medical expenses, not timely go through the discharge formalities, artificially increased the discharged patients of bed; Some patients think that the longer the length of hospital stay, the condition is better, there are patients out of distrust for the doctor, not prescribed behavior, lead to the extension of such confinement on average; Relatives of patient don’t rest assured, will be offered to extend the length of hospital stay of patients; Patient area hospital, a doctor to operate on the specified, lead to preoperative hospitalization time, extending the length of hospital stay.3, Hospital internal factors include:(1) Diagnosis and treatment work flow is not enough scientific, convenient, efficient, or poor process operation; the patient cannot get timely diagnosis and treatment. Concrete manifestation in:①Patients with hospitalized, lack of medical human resources;②Clinical doctors knowledge of sickbed work efficiency is not comprehensive, many physicians to shorten the average importance of such confinement is no correct understanding; Diagnosis and treatment level of medical staff is limited, diagnosis and treatment norms, such as medical core management system implementation does not reach the designated position;④Consultation system may not be implemented, required of other disciplines consultation patients waiting for consultation time is too long;⑤Patients has to be waiting a long time.For surgery, for turning of surgical treatment of patients transferred to the department Ward no spare beds not timely transfer.⑥In order to improve the ward beds in utilization artificially prolong hospital stay.(2)Inspection, examination and other medical ancillary departments efficiency is limited by the performance in:①Hospital inputs, ancillary departments check medical technology, testing equipment cannot meet the needs of the clinical work;②Check, inspection, and medical equipment such as aging or improper maintenance, resulting in equipment failures happen more, affecting the quality and efficiency of medical technology departments work;③Medical Technology shortage of staff, amounted to less than the proportion of hospital should not meet the clinical demand;④Appointment, wait for the check as well as issuing inspection report single process requires manual processing chain, inspection, examination department information processing is not enough time.(3) The ward care quality and efficiency is not high. Mainly because:(1) Disease area inpatient too manpower shortage of nurses, nurses working excessive pressure;②Nurses working efficiency is not high, and not enough time to perform a clinical lead to the patient’s various inspection, testing, treatment cannot be timely completed;③Disease district nursing work in place, to cause patients had nosocomial infections and complications;④Patient was discharge criteria failed to discharge formalities.(4) Hospital management, quality management, performance management is not standard, scientific, efficient and refined. Mainly displays in:quality index, the medical staff and patients to shorten the average length of stay①The hospital total cost accounting is not enough refinement, uneven distribution of resources in hospitalized patients should be timely completion of the inspection and testing is not completed in time, prolonged hospitalization in the average hospitalized patients; Implementation does not reach the designated position,②The hospital performance management performance appraisal index and the design is not science, not the average such confinement in such confinement, preoperative assessment of medical quality index, the medical staff and patients to shorten the average such confinement of consciousness and enthusiasm is not high;③Incentive mechanism is not perfect, some doctors in patients with shortened average such confinement or even conflicting phenomenon;④Hospital background information management system is not scientific, efficient, functional management departments work efficiency is low, logistics does not reach the designated position, affects the work quality and efficiency of clinical departments;⑤Single disease quality management and clinical pathway work is not perfect.Second, hospitals can take the following measures to reduce the average length of stay of surgical patients.1, The hospital management level can take the following ways to reduce the average length of stay:improve the benefit consciousness for management, innovate the management mechanism, achieve the elaborating management, implement comprehensive-goal management, improve the level of information processing and logistics, strengthen the single disease quality management and perfect the clinical pathway, a good job of two-way referral and shunt implementation measures2, Measures of ward management level include:implement performance appraisal points for professional; improve medical service model; Optimize the diagnosis and treatment processes; Strengthen quality management, improve the level of diagnosis and treatment; Improve the quality of the ward nursing service; Develop new business, adopt the "daytime" mode; strengthen the construction of hospital group; strengthen the monitoring and management of super long-time stay.3, Department of medical level:(1) To do a good job of procurement and maintenance of medical equipments, medical equipments of hospital of scientific Reasoning to medical equipment needs, completes the inspection, testing and other large equipment procurement plans, add or update equipments in a planned way. In equipment use process, strengthen management and maintenance, completes the medical equipment use and maintenance of records, ensure utilization and intact rate of medical equipment.(2) To strengthen the construction of talent-team. Medical departments should attach great importance to the training of technical personnel and talents more. Medical department is usually with the help of the advanced medical equipments to carry out the work, and the work level and efficiency, to a great extent, depend on the degree of advanced medical equipments and medical department personnel professional level of technology and knowledge update-speed.(3) Design strict work attendance checking system to improve staffs motivation. Among department staff, director of the department of medical can take some appropriate incentive methods, such as making a reasonable income distribution system, implementing prize award for employee diligence to punish the lazy strategy, encouraging everybody to work during the shortage of personnel department, and raising the payment during weekend and overtime work, fully arousing staff’s enthusiasm.Innovations and deficienciesThis paper analyzed the influence of the relative factors about average length of stay and the implement of clinical pathway in stay days. Innovation is that with the help of fishbone diagram, to classify the average system and describe the system directly. Finally, in view of the factor analysis, this study respectively lists concrete opinions and measures to shorten average length of stay in hospital, concerning the hospital ward management, management, and the department. Deficiency of this paper is that not tracking, investigating and analyzing every factor which influences the average stay length of surgery patients in detail. Furthermore, some factors lack Specific data to get supported, and can only be given from the perspective of qualitative analysis. In the later studies, these factors can be discussed in detail. More detailed solutions and solutions will be put forward in the level of refinement analysis factors affecting average stay length. |
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