国家三级公立医院绩效考核导向下地市级三级公立医院发展日间手术的探索与实践

Practice and development of day surgery for municipal third-level public hospital under guidance of national hospital performance appraisal system

目的 分析在国家三级公立医院绩效考核(简称“国考”)导向下宜宾市第二人民医院·四川大学华西医院宜宾医院(简称“我院”)实施并推进的日间手术的成效。方法 收集我院2016–2022年期间逐年的国考相关指标数据,分为国考前期(2016–2018年)、国考初期(2019–2020年)及国考近期(2021–2022年)3个阶段进行分析,了解各阶段国考相关指标的变化趋势及相关性。结果 我院日间手术从2018年起步,日间手术占择期手术比例在2018年仅为1.2%,随后持续增至2022年的34.7%;2016–2022年期间,出院患者手术占比从2016年的22.4%持续增至2022年的35.7%,全院平均住院日从10.9 d逐步降至8.1 d;相关性分析发现,日间手术占择期手术比例指标与出院患者手术占比和全院平均住院日指标存在高度线性相关性(rs=0.93,P=0.002;rs=–0.99,P<0.001)。在国考近期,日间手术后再手术率<0.1%、日间手术出院后再入院率为0%,日间手术住院患者满意度均超过95.0%,至2022年达97.0%,高于全院住院患者满意度平均水平。以腹腔镜下胆囊切除术、白内障超声乳化及人工晶体植入术、内固定取出术、声带息肉切除术、内镜下胃息肉术切除5种术式为例,日间模式的住院次均费用及除药耗外住院次均费用均较传统择期手术下降。结论 在国考导向下,我院日间手术已进入发展上升阶段,提示作为公立医院综合改革重要内容的推进日间手术模式成效明显,但尚需通过推进规范化、精细化和信息化的日间手术管理以带动医疗质量高质量发展的内涵建设。

Objective To analyze the efficacy of promoting the development of day surgery in a municipal third-level public hospital under the guidance of national hospital performance appraisal system.Method The annual data relevant day surgery in the Yibin Second People’s Hospital were collected from 2016 to 2022,which were divided into three stages:2016–2018,2019–2020,and 2021–2022.The trend and correlation of the performance appraisal indicators were analyzed.Results The day surgery in the Yibin Second People’s Hospital started in 2018,and its proportion in the elective surgery was only 1.2%in 2018,then increased continuously after the implementation of performance appraisal system,and was up to 34.7%in 2022.From 2016 to 2022,the proportion of discharged patients underwent surgery in the entire hospital increased continuously from 22.4%in 2016 to 35.7%in 2022,and the average hospital stay in the entire hospital gradually decreased from 10.9 d to 8.1 d,which both had a significant linear correlation with the proportion of day surgery in the elective surgery(rs=0.93,P=0.002;rs=–0.99,P<0.001,respectively).In the recent implementation of performance appraisal system,the re-operation rate after day surgery was less than 0.1%,the readmission rate of day surgery after discharge was 0%,and the satisfaction rate of day surgery patients was more than 95.0%,which reached 97.0%by 2022,higher than the average level of inpatient satisfaction in the entire hospital.Taking laparoscopic cholecystectomy,cataract phacoemulsification and intraocular lens implantation,internal fixation extraction,vocal cord polypectomy,and endoscopic gastric polypectomy as example,the average total hospitalization cost and average cost excluding drug and medical materials consumption of the day surgery all decreased compared to non-day-surgery mode,respectively.Conclusion Under the guidance of national hospital performance appraisal system,day surgery has entered a rapid developing stage,but it is still necessary to promote the medical quality by standardized,precise,and informationized day surgery management.