择限期手术当日取消成因分析

Cause Analysis for the Cancellation on the Day of Elective/Deadline Surgery

目的分析择期/限期手术临时取消的原因,并提出相应的管理对策,以期降低择期/限期手术的临时取消率,促进手术室医疗资源的有效利用。方法调查并纳入2018年1月1日至12月31日期间,四川大学华西医院所有通过电子系统进行排程的择期/限期手术。收集各专科手术当日临时通知手术室取消的择期手术病例、所在科室及取消原因,并根据具体分析情况提出相应的护理管理对策。结果共纳入103140例通过电子系统进行手术排程的外科手术病例,当日手术取消18050例,取消率为17.5%。各个科室之间择期/限期手术取消率差异较大,最低的为甲乳外科(6.1%),最高的为肝脏外科(46.0%)。同时,总体来看,最为常见的择期/限期手术取消原因为超过医院规定的接台时间(24.3%),其次为患者及家属意见改变(8.9%),其余因素主要为患者术前检查异常或未完善以及突发临时事件(发热以及女性患者月经来潮等)。结论择期/限期手术当日取消率较高,多种因素综合作用是导致手术当日取消的原因。优化手术排程计划与措施、加强医护患沟通、手术取消登记并作出相应测评与绩效挂钩等管理措施,从而降低择期/限期手术当日取消率,减少对有限手术室医疗资源的浪费以及对患者心理造成不良影响,促进手术室资源的有效利用。

Objective To analyze the reasons for the urgent cancellation of elective/deadline surgeries and put forward corresponding management countermeasures,so as to reduce the urgent cancellation rate of elective/deadline surgeries and promote the effective utilization of medical resources in the operating room.Methods All elective/deadline surgeries scheduled by electronic system in West China Hospital of Sichuan University from January 1 to December 31,2018 were investigated and analyzed.The elective surgery cases of different departments urgently cancelled on the surgery day and reasons given for the cancellation were collected.Corresponding nursing management countermeasures were put forward according to specific analysis.Results A total of 103,140 cases of surgical operations scheduled by electronic system were included,and 18,050 cases were cancelled on the surgery day,with a cancellation rate of 17.5%.The cancellation rate of elective/deadline surgeries varied greatly among different departments,with the lowest rate in the department of thyroid and breast surgery(6.1%)and the highest rate in the department of liver surgery(46.0%).Besides,in general,the most common reason for canceling elective/deadline surgeries was the late arrival at the operating room according to the hospital's regulations(24.3%),followed by the change in the decision of the patients and their families(8.9%).Other factors mainly included abnormal or incomplete preoperative examination of the patients and other unexpected incidents,such as fever and menstruation of female patients,etc.Conclusion The cancellation rate on the day of elective surgery was relatively high,which was caused by a combination of factors.It is necessary to optimize operation scheduling plan and measures,strengthen communication among doctors,nurses and patients,improve the registration of cancellation,and take corresponding management measures related to evaluation and performance,so as to reduce the cancellation rate of elective/deadline surgeries on the surgery day,to avoid the waste of limited medical resources in the operating room as well as the adverse impact on patients'psychology,and to promote the effective utilization of operating room resources.