Establishment Of Evaluation Index System For Enhanced Recovery In Hepatobiliary Surgery Based On Zero Defect Management Theory

Part oneTo construct a set of evaluation index system for enhanced recovery in hepatobiliary surgery ward,to provide scientific basis for evaluating the effect of enhanced recovery after surgery,and to continuously improve the quality of nursing care.Part twoThe evaluation index system constructed in this study covers many indicators,most of which can be directly quantified,but some of the standard values of indicators can not be directly obtained.In order to better determine the standard values of some indicators,two indicators of patient satisfaction and effective nursing hours in the evaluation index system were studied.MethodsPart oneEstablishing the evaluation index system of enhanced recovery in hepatobiliary surgery.Based on the theory of zero defect management and through clinical investigation,important nursing items of enhanced recovery after surgery in hepatobiliary surgery were preliminarily formulated.Using Delphi expert consultation method,a total of 30 experts who proficient in accelerating rehabilitation surgery were invited for consultation.According to the experts’ suggestions,the evaluation index system of enhanced recovery in hepatobiliary surgery will be carefully revised prior to its final determination.Part twoAccording to the preliminary evaluation index system,in order to better determine the standard values of some indicators,the questionnaire of inpatients’ satisfaction in enhanced recovery after surgery and the questionnaire of direct and indirect nursing items were designed.(1)A questionnaire of direct and indirect nursing items in enhanced recovery after surgery was developed by literature analysis and expert consultation.Nursing staff in hepatobiliary surgery wards were assessed their nursing workload based on the method of man-hour measurement.The allocation standard of nursing human resources in this ward was calculated by using the related formula of human resources allocation,so as to determine the standard value of effective nursing hours.(2)To develop a questionnaire for inpatient satisfaction in enhanced recovery after surgery.A questionnaire on inpatient satisfaction in enhanced recovery after surgery was developed by literature study and Delphi expert consultation method.The reliability and validity of the questionnaire were tested.ResultsPart oneThrough two rounds of Delphi expert consultation,experts’ opinions tend to be consistent.The effective recovery rate of the two rounds of questionnaires was 100%,and the authoritative coefficients of experts were between 0.918-0.920,respectively.Finally,an evaluation index system for accelerated rehabilitation of hepatobiliary surgery was formed,including 3 dimensions which are control system,operation management and guarantee system.They are further divided into 3 class-I indicators,8 class-Ⅱ indicators and 39 class-III indicators.Part two(1)By designing the questionnaire of direct and indirect nursing items,62 items of nursing items were established,including 40 items of direct nursing and 22 items of indirect nursing.The results showed that the nursing time provided by nurses in the ward for each patient was 139.16 minutes per day.Direct nursing time and indirect nursing time accounted for 62.84%and 37.16%of total nursing time,respectively.The suitable ratio of nurse/bed was 0.64 and the actual ratio of nurse/bed was 0.50.(2)To test the reliability and validity of the inpatient satisfaction questionnaire of enhanced recovery in hepatobiliary surgery.The scale consists of 4 factors and 17 items.The Cronbach’s alpha coefficient of the total table was 0.907,and the Cronbach’s alpha coefficient of each factor is between 0.719-0.843.The half-split reliability was between 0.868-0.817,respectively,and the correlation coefficient between the two parts was 0.667.Four common factors were extracted by principal component analysis,and the cumulative contribution rate was 63.662%.The Pearson correlation coefficients among the factors were 0.237-0.402,and the Pearson correlation coefficients between the factors and the total score of the scale were 0.216-1.000.ConclusionPart oneOn the basis of extensive literature review at home and abroad,based on zero defect management theory and Delphi expert consultation method,the evaluation index systemof enhanced recovery in hepatobiliary surgery was constructed.Its structure was scientific and reasonable,and its content was comprehensive and systematic.The statistical results showed that the coordination coefficient and authority coefficient of expert consultation were higher,which indicated that the credibility of the consultation results was higher.The establishment of this index system can provide objective and quantifiable basis for the evaluation of nursing quality in hepatobiliary surgery wards of enhanced recovery after surgery.Part two(1)This method can accurately measure nursing workload and provide theoretical basis for speeding up the rational allocation of nursing human resources in enhanced recovery after surgery wards.The proportion of nurses in this ward was relatively low.It can be improved by improving nursing workflow,arranging nursing work content reasonably and increasing the number of nurses.(2)A questionnaire with good reliability and validity was preliminarily formed to provide a good evaluation tool for the evaluation of clinical nursing work in enhanced recovery after surgery wards.