四川省某三级医院日间手术当日取消原因及精细化管理运用效果分析

Reasons for same-day cancellation of ambulatory surgery and the application of refined management in a tertiary hospital in Sichuan province

目的分析日间手术当日取消的原因,探索降低日间手术取消率的优化管理方案及干预措施。方法对2020年4月至2022年7月在我院日间手术中心集中管理的日间手术当日取消病例进行回顾性研究,分析术前精细化管理实施前后的手术取消情况及其原因。结果术前精细化管理实施后,手术当日取消率由实施前的2.44%降至1.88%,差异有统计学意义(χ^(2)=6.064,P=0.014),其中腹腔镜胆囊切除术改善突出,降至1.30%,差异有统计学意义(χ^(2)=9.829,P=0.002)。对日间手术当日取消的原因进行分析后发现,精细化管理实施前采用常规管理时,医方因素占41.88%,疾病因素占31.88%,患方因素占26.25%。精细化管理实施后,其比例为医方因素占25.35%,疾病因素占39.44%,患方因素占35.21%。结论充分重视术前管理、完善手术管理制度、优化实施流程、提高医护人员业务能力、加强医患沟通和患者健康教育,可有效降低日间手术当日取消率,对于提升整体医疗质量大有裨益。

Objective To investigate the reasons for the same-day cancellation of ambulatory surgery and to explore an optimized management protocol and interventions to minimize the cancellation rate.Methods A retrospective analysis was performed on the cases of same-day cancellation of ambulatory surgery procedures that were centrally managed at the Ambulatory Surgery Center of our hospital from April 2020 to July 2022.The impact of preoperative meticulous management on the cancellation rate was also examined.Results Following the implementation of preoperative meticulous management,the same-day cancellation rate for surgical procedures 2 significantly decreased from 2.44%to 1.88%(χ^(2)=6.064,P=0.014).In particular,the same-day cancellation rate for laparoscopic 2 cholecystectomy significantly dropped to 1.30%(χ^(2)=9.829,P=0.002).Before the introduction of meticulous management,41.88%of cancellations were attributed to medical factors,31.88%to disease-related issues,and 26.25%to patient-related factors;after the implementation of meticulous management,the distribution of reasons for same-day cancellations shifted to 25.35%due to medical factors,39.44%to disease-related issues,and 35.21%to patient-related factors.Conclusion Improvements in preoperative management,surgical management system,implementation processes,capacity-building of medical staff,doctor-patient communication,and patient health education contribute to a substantial reduction in the same-day cancellation rate of ambulatory surgery,thereby benefiting the overall medical quality.