The First Affiliated Hospital of Harbin Medical University has recently established the first day surgery center in Heilongjiang Province, with plans to set up seven operating rooms and 100 beds. The first batch recommended 56 types of surgery involving ophthalmology, gastroenterology, hepatobiliary surgery, otolaryngology and other departments.
Medical staff at the surgery center perform the first day surgery.
Day surgery is an internationally popular surgical model. It is not an outpatient surgery, but an inpatient surgery, but it takes only 24 hours from surgery to discharge. Is the safety of such a short and quick surgery guaranteed? Can I recover after surgery? After the hospitalization cycle is shortened, can the problem of the difficulty in finding a bed in big hospitals be alleviated? What obstacles have been encountered in the promotion of this new surgical model? From today, we launch a "day surgery" special report, hope to help you understand a full range of day surgery.
Can costs be reduced?
From the perspective of health economics, day surgery mainly reduces the indirect economic burden of disease on patients, including not only the various costs incurred by family members accompanying the patient, but also the patient's cost of waiting
"If the postoperative observation is normal, you can be discharged home the same day in the evening." Wu Weidong, a patient in Chengdu, Sichuan province, was lying in his hospital bed, waiting for his surgery while receiving fluids. He was a little confused: how can he be discharged so quickly? His wife sat by the side and kept comforting him. Two days ago, he had a sudden sharp pain in his abdomen and went to the emergency room of West China Hospital, where he was diagnosed with acute cholecystitis and required surgery. After the doctor's assessment, Wu Weidong meets the criteria for day surgery.
"The first surgery has begun at 9:00, and it will be his turn soon." The nurse said to reporters, Dai Yan. The surgeon drew three forks in Wu Weidong's abdomen with a red pen, which is the location for laparoscopic cholecystectomy. About a quarter of an hour later, Wu Weidong was wheeled into the operating room.
Laparoscopic cholecystectomy is a common surgical procedure, and while traditional surgeries usually require a five-day hospital stay and cost about 9,000 yuan, daytime surgeries require only one day of hospitalization and cost about 7,000 yuan. Wu Weidong recovered at home after the operation, and the doctor followed up with regular phone calls for a week. Wu Weidong feels that this mode of surgery is good, with a short hospital stay, and is more comfortable at home than in the hospital.
"Hospitals are by no means the best place for patients to recover." Wen Daxiang, vice chairman of the Shanghai Day Surgery Management Specialized Committee and vice president of Renji Hospital, said the development of anesthesia and minimally invasive technology has made the surgery less and less traumatic for patients, and the hospital stay has been shortened accordingly, and the normalized home environment not only reduces the risk of cross-infection, but also is more conducive to physical and mental recovery.
"From the point of view of health economics, day surgery mainly reduces the indirect economic burden of disease on patients." Zhao Rong, chairman of the Shanghai Day Surgery Management Specialized Committee and director of Shenkang's medical business unit, explained that the indirect economic burden of disease includes not only the various costs incurred due to family members accompanying the patient, but also the patient's waiting costs. Especially in first-tier cities such as Shanghai, the greatest success of day surgery is that it improves the accessibility of medical services. A survey conducted by the Shenkang Hospital Development Center of six pilot hospitals in Shanghai that have implemented day surgery found that the average total medical cost has dropped 17.51 percent compared to the same period in the past.
Zhang Zhenzhong, chairman of the China Day Surgery Cooperative Alliance, said day surgery refers to surgeries where patients are admitted to and discharged from the hospital within 24 hours. Day surgery is not outpatient surgery, special cases due to the condition of the patient needs to be postponed hospitalization, the maximum length of hospitalization does not exceed 48 hours.
Day surgery first originated in developed countries in Europe and the United States, and became more and more mature after entering China in 2001. in March 2012, the Health Development Research Center of the National Health and Planning Commission took the lead in organizing the China Day Surgery Cooperation Center (CDSC), which includes Shanghai Shenkang Hospital Development Center, Huaxi Hospital of Sichuan University, Peking Tongren Hospital, Wuhan Women's and Children's Medical and Healthcare Center, Xiangya Hospital of Central South University, Shanghai First People's Hospital, Shanghai Renji Hospital, and so on. On May 6, 2015, the National Health Planning Commission and the State Administration of Traditional Chinese Medicine (SATCM) issued the Notice on the Action Plan for Further Improvement of Healthcare Services, specifically proposing the "implementation of day surgery". The General Office of the State Council "to deepen the reform of the medical and health system in 2017 key tasks" proposed to organize and carry out day surgery pilot in tertiary hospitals.
Is it safe to be discharged on the same day?
If a patient develops serious complications during or after surgery, he or she will be transferred to a specialized ward through a green channel to continue treatment. After patients are discharged from the hospital, they can be admitted directly to the hospital from the green channel in case of serious complications
Among minimally invasive gynecological surgeries, laparoscopic total hysterectomy is considered a major surgery. Usually, patients need to be hospitalized for about 5 to 7 days. Now, Renji Hospital has turned it into a day surgery, with all the routine pre-operative laboratory tests and anesthesiology visits done on an outpatient basis, one by one. Ms. Zeng, who has suffered from uterine fibroids for several years, completed her hospitalization at the hospital's Day Surgery Center and was discharged home the same day. Since September 2015, the gynecology department of Renji Hospital has extended the "day mode" to laparoscopic total hysterectomy and laparoscopic fibroid removal, which can be described as a "bold art".
However, it is not easy for patients to accept the idea of day surgery. West China Hospital Day Surgery Center Director Ma Hongsheng recalls, in October 2009, the hospital day surgery just started, *** set up 24 beds and six separate operating rooms. Due to safety concerns, patients did not buy it. The wards were closed, with only about 10 patients a day.
With the development of minimally invasive surgery, as well as anesthesia and anesthesia resuscitation technology has become more mature, day surgery quickly "popular". Patients from the distrust to openly accept. Zhang Zhenzhong said that the medical institutions to carry out day surgery, generally have more detailed pre-operative assessment process than traditional hospitals, more advanced operating room conditions and equipment, more professional and more experienced surgeons and anesthesiologists, a more scientific process, more perfect post-operative follow-up system.
What kind of patients can receive day surgery? What kind of doctors can perform day surgery? The Day Surgery Center of West China Hospital has formulated a complete set of medical quality and safety measures for day surgery, including the admission standards for doctors, patients and surgical procedures, the assessment standards for anesthesia before admission, discharge from the recovery room, and discharge from the hospital, as well as the emergency plan during hospitalization and after discharge and the post-discharge follow-up plan. West China Hospital stipulates that if a patient develops serious complications during or after surgery, he or she will be transferred to a specialized ward through the green channel to continue treatment; if the discharge assessment fails to meet the appropriate criteria, he or she will be transferred to the appropriate ward or be hospitalized by the community health service organization; and if there are serious complications after discharge, he or she can be contacted with the Day Surgery Center's follow-up staff through the follow-up phone number and be admitted directly to the hospital for treatment from the green channel.
How safe is day surgery? Clinical statistics provided by Liu Yang, a doctor at the Day Surgery Center of West China Hospital, show that from March 2014 to December 2016, there were 1,623 cases of day laparoscopic cholecystectomy patients, and routine telephone follow-ups were conducted for all patients on the first, second, third and thirtieth days after discharge. The results showed that there were 311 cases of various discomfort symptoms with an incidence of 19.16%, of which the anesthesia-related incidence was 18.3%, post-surgical complications were 0.86%, and overall patient satisfaction was 99.63%.
"Short and quick" day surgery is favored by more and more hospitals. So, which diseases are suitable for daytime surgery? Zhang Zhenzhong said, China Day Surgery Cooperative Alliance in the preliminary research on the basis of the official launch of 56 suitable for day surgery, covering digestion, orthopedics, ophthalmology and other nine disciplines. The alliance will further introduce relevant surgical norms and standards by way of expert proof.
"There is nothing more important than the quality and safety of surgery." According to Zhang Zhenzhong, hospitals joining the Day Surgery Alliance must have independent day surgery centers with a surgical volume of no less than 5% of the total number of elective surgeries to ensure the quality and safety of day surgery.
Can the difficulty of hospitalization be alleviated?
China's average hospitalization in large hospitals is 8-9 days, while the U.S. is 4-5 days, the gap is day surgery. To carry out day surgery, not only can shorten the patient's hospital stay, but also accelerate the hospital bed turnover rate, is a win-win road for doctors and patients
Cao Jiaozuo, Henan, suffered from glaucoma need to do surgery, in Beijing, a well-known eye hospital to do the examination, the doctor issued a hospitalization order, the date of the operation scheduled for three months later. Cao Mou a bit anxious, the condition does not wait for people, can take so long? The doctor said, hospitalized patients are too many, really can not spare beds, go home and wait for the phone call.
Big hospitals are hard to find a bed, has become a common phenomenon. The development of day surgery, can shorten the patient's hospitalization time, but also to speed up the turnover rate of hospital beds, is a win-win situation for doctors and patients out of the way.
Jiao Yahui, deputy director of the Medical Affairs Bureau of the National Health Planning Commission, said that simple surgeries like appendicitis and inguinal hernia, with an average hospitalization of seven or eight days, take up limited bed resources. If put into the day surgery center to carry out, it can save a lot of beds, so that tertiary hospitals to focus on the admission of difficult and serious patients.
Experts pointed out that the Peking Union Medical College Hospital, Huaxi Hospital, the People's Liberation Army General Hospital beds are more than 2,000, while the U.S. large hospital beds are generally in the United States about 1,000. In addition to demographic factors, the average hospitalization day in China's large hospitals is 8-9 days, while the United States is 4-5 days, the gap is day surgery. The day surgery model has developed rapidly in Europe and the United States, becoming the main mode of surgery, and day surgery now accounts for more than 60% of elective surgeries in many countries, and even as high as 70% and 80% in the United Kingdom and the United States. By the end of 2016, more than 2,000 medical institutions in China carried out daytime surgery, and the proportion of daytime surgery to elective surgery was only 11%.
The Outline of the National Healthcare Service System Plan (2015-2020) requires that the number of beds in provincial-run and above general hospitals should generally be around 1,000, and in principle no more than 1,500; the size of beds in specialized hospitals should also be tightly controlled according to actual needs. The state strictly prohibits blind expansion of hospitals and will promote the development of day surgery at the policy level.
"The model of ambulatory care is an important means to enhance medical services, hospitals can realize the restructuring of hospital supply without expanding beds." Zhang Zhenzhong said that to carry out the daytime medical model, it is necessary to focus on the needs of patients, constantly expand the effective supply of medical services, improve the medical service process and service quality from the details, and enhance the public's sense of access to medical care.
Shanghai Renji Hospital statistics are very convincing. 2016, the hospital completed more than 30,000 cases of day surgery, accounting for more than 40% of the hospital's surgery, with an average hospitalization day of 1.12 days, while the average hospitalization day of non-day surgery patients was 9.16 days. The improved efficiency in resource utilization has enabled Renji Hospital to achieve the highest number of discharged surgeries in Shanghai with 1,400 beds.
Jiao Yahui said, day surgery is the re-engineering and optimization of the clinical surgical process, can make full use of hospital bed resources, with high efficiency, convenient process, short hospital stay and low cost, in line with the development direction of modern hospital management. Vigorously promote day surgery is a public hospital to improve service, improve quality and control costs of an important initiative.