| In China,day surgery is still at the beginning.The management model of day surgery is mainly decentralized management.With reference to the management experience of the benchmark hospital,the clinical department is used to implement empirical management.With the gradual deepening of day surgery,the extensive decentralized management model has been unable to adapt to the needs of the current day surgery development situation.Since the initial understanding of day surgery in hospitals has not yet been agreed,there is no uniform standard for patient admission criteria and day surgery admission standards,which results in the lack of effective management standards and operating modes for day surgery management.There is unnecessary time-consuming in the provision of day surgery services,and all departments were chaotic,the operation of the day surgery is not smooth enough and the benefits are less than expected.In order to solve these problems,it is required that the hospital should to change the day operation management mode according to its own situation,optimize the analysis of the problems in the operation process,and improve the operation efficiency and management efficiency of day surgery.S Hospital is a comprehensive large-scale Grade-A public hospital.Since the day surgery was carried out in 2016,due to the lack of management experience,hospital procedures for day surgery did not result in scientific practices.Patients who underwent day surgery were admitted to the hospital with a phenomenon of"compounding",medical records were complicated to fill in,patients were unfamiliar with the medical procedure and environment,education was not standardized,the operating table of day surgery was not properly scheduled,and postoperative recovery services did not meet the characteristics of quick discharge from the surgery,etc,making it difficult to implement day surgery in S hospitals.PurposeIn order to improve operational processes and problems of day surgery in S hospitals,this study took S hospital ophthalmology as an example to sort out the problems that occurred in each link of day surgery hospitalization process,analyze the causes of the problems and proposed process improvement plan.To reduce the time spent on ophthalmic day surgery hospitalization process,speed up the circulation of patients,promote the development and promotion of day surgery,improve hospital medical service capabilities,and provide patients with more quality and efficient medical services.MethodsThe study focused on all the links involved in the general hospitalization process and procedures for all day surgeries in S hospitals.Through the observation method and the questionnaire,we tracked the hospitalization process of 50 patients who underwent day surgery before and after the process optimization(August 2017,December 2017),and collected the time spent in each link of the day surgery hospitalization process and patient's opinions and suggestions on their hospitalization process.At the same time,we combined the interview method to summarize the main problems and optimization recommendations in the ophthalmic day surgery hospitalization process in S hospitals.Using the DMAIC Six Sigma classic model in the process optimization method,through Six Sigma define-measure-analyze-improve-control(DMAIC)process,combing and analyzing the main issues in the hospital ophthalmic day surgery hospitalization process,determine the critical-to-quality(CTQ),develop a process optimization plan and implement them.The time spent in each link of the hospitalization process and the hospitalization process capacity before and after optimization were compared and analyzed,based on the phase effect of the program and improve it to get an optimization proposal for the ophthalmic day surgery hospitalization process in S hospital.ResultAfter the implementation of the optimized plan,the ophthalmic day surgery hospital procedure capacity was significantly improved from the 0.90 a to 1.54 a.The hospitalization time of day surgery patients dropped from 958.94 min to 681.72 min,the time consumed of the longest preoperative waiting period and postoperative recovery period in the hospitalization process decreased from 167.52 min and 587.82 min to 123.1 min and 372.84 min respectively,both were statistically significant(P<0.05).The average length of stay and average hospitalization expense for ophthalmology inpatients reduced from 4.19 days and 6,796 yuan to 3.38 days and 4,715 yuan respectively after the optimization,both were statistically significant(P<0.05).And in the satisfaction survey,internal and external research subjects have significantly improved the image of the optimized ophthalmic day surgery hospital procedure,in particular,patient satisfaction increased from 14%to 82%.The day surgery hospitalization process optimization has achieved provisional progress,but due to the limited research time,the day surgery management model and Enhanced Recovery After Surgery(ERAS)in the process optimization plan have not been officially launched,establish an ERAS system for rapid postoperative rehabilitation,to optimize hospital procedures for day surgery.ConclusionThe optimization of the day surgery hospital procedure is significant.Starting from the day surgery operation process,optimize day surgery management modes and operation methods with scientific process optimization methods and tools,it will help speed up the operation of day surgery,and promote the popularization of day surgery.The optimization of the day surgery procedure can be started from the concept and management mode of day surgery,and combined with the specific operation flow,acting on the process optimization. |
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