日间手术模式下泪道疾病手术治疗患者的优质护理

目的探讨日间手术模式下的泪道手术患者的优质护理。方法收集2015年10月~2016年3月61例日间泪道手术患者的相关数据,进行统计分析。结果日间手术模式下手术治疗61例泪道疾病患者,手术配合良好,手术过程顺利,住院期间无不良事件和术后并发症的发生,出院患者满意度大于99%。结论日间手术短、频、快的特点,适宜泪道疾病患者的手术治疗;标准化泪道疾病日间住院流程,方便患者的住院治疗;医护人员严密观察患者病情,采取多形式健康教育,可缓解患者的紧张、焦虑情绪,保证治疗质量和安全,提高患者住院体验和满意度。     

模糊失效模式与效应分析在优化胸外科日间手术流程中的应用

目的 对胸外科日间手术流程中存在的障碍进行分析，了解影响胸外科日间手术工作效率的因素，为优化日间手术工作流程提供建议和科学依据。方法 采用基于模糊理论的失效模式与效应分析法，对2019-2020年上海市某肺部疾病专科医院的日间手术流程进行分析，筛选影响手术流程的高风险因素，提出改进措施并实施。结果 整改后，胸外科日间手术患者的手术取消率（0.72%）低于整改前（2.92%），患者进入手术室后的等待时间及复苏后等待转出的时间均明显缩短，差异均有统计学意义（均P<0.05）。结论 模糊失效模式及效应分析法可以有效优化胸外科日间手术工作流程，提高日间手术室的工作效率。     

骨科日间手术的安全管理

目的:探讨骨科日间手术患者的安全管理流程及策略,确保日间手术新型住院模式下患者安全与医疗质量。方法:对310例骨科日间手术患者采用安全管理,包括患者管理、流程管理、护士培训、医嘱管理、病室安排和应急预案的制订等方面,并评价新型护理安全管理模式的效果。结果:310例骨科日间手术患者在新型护理安全管理模式下,均在24小时内安全出入院,无护理安全差错发生。结论:骨科日间手术安全管理对手术的顺利进行和日间手术新型住院模式的发展,起到了积极的推动作用。     

冠状动脉造影检查实施日间手术模式的护理

总结了147例日间手术的冠状动脉造影患者的护理体会。主要包括患者的收治标准、入院流程及围术期的护理等。认为冠状动脉造影检查实施日间手术模式能让患者在短期内得到有效的治疗和护理,降低住院天数,减少患者费用。     

老年日间手术患者家属对日间手术住院流程体验的感知

目的 探究老年日间手术患者家属群体对当下日间手术流程的感知与需求。方法 通过访谈的方式了解老年患者家属对日间手术流程的体验与需求,提出相应改进建议,为临床适老化日间手术流程的构建提供依据。结果 老年患者家属对于日间手术流程的体验感普遍良好,表示医护人员能够耐心倾听并从专业的角度解答疑问,但也提出了日间手术等候时间过长、心理准备不足等问题,表达了人文关怀、信息支持和延续性护理的需求。结论 适老化日间手术流程模式可以从加强人文关怀、完善信息支持系统和延续性护理服务着手,降低老年患者家属的焦虑感,促进适老化日间手术流程的优化与老年友好型医疗护理环境的发展。     

日间手术患者护理管理模式应用效果分析

目的分析评价我院日间手术患者护理管理模式改进效果。方法结合本院"院中院"管理模式、"院前检查"手术治疗模式和日间手术特点,从患者住院管理和护理人员管理两方面分三步对日间手术护理管理模式进行改进,从护理人员参与日间手术管理、住院流程管理、术前访视制度改革,加强术后支持护理方面进行改进,建立日间手术护理人员管理制度,提高住院患者满意度。结果日间手术患者对院前检查模式的满意率达95%以上,日间手术的术前等候时间明显缩短,患者对护理工作的满意率和满意度得分也不断提高。结论通过对日间手术室护理管理模式的改进,有效地提高了患者满意度、满意率,降低了术前等候时间,使有限的卫生资源得到合理使用,加快了医院床位周转,真正使患者得到快速诊治和优质护理服务。     

日间手术病房管理护理模式实践

日间手术病房能使手术后病人在短期内得到有效的治疗、护理和健康教育。本文结合日间手术病房的流程特点,报道了日间手术病房患者接待、治疗、护理、医疗安全、健康教育、术后随访等环节的病房管理护理模式实践。临床实践结果显示,日间手术病房能有效保障病人医疗安全,降低病人住院天数,减少病人医疗费用,病人满意度达98%以上。     

“集中管理+分散收治”日间手术管理模式经验分享

规范开展日间手术可显著提高医院医疗效率,降低医疗成本,提升患者满意度。郑州大学附属郑州中心医院针对日间手术管理的难点和运行“堵点”,参考结合国内外已有的日间手术收治模式,形成适合医院的“集中管理+分散收治”日间手术模式。该文详细介绍了该管理模式的管理架构、运行流程、延伸服务等,为日间手术诊疗流程优化和医疗服务效率提升提供思路。     

部队某大型综合医院集中收治模式日间治疗服务现状的调查分析

目的 分析部队某大型综合医院集中收治模式日间治疗（除日间手术以外的其他日间医疗）服务的开展现状,为推行日间治疗集中收治模式的管理及运营等方面提供实践支持。方法 回顾性收集2021年2月7日—2023年12月31日解放军总医院第一医学中心日间诊疗科集中收治模式日间治疗患者的资料,对患者情况、日间治疗运行指标及质控指标进行统计分析。结果 日间治疗患者共14 903例,其中女8 548例,男6 355例;年龄18～74岁;住院次数≥2次者9 757例（65.47%）;支付方式以医保为主（83.16%）。以乳腺癌为主要诊断的患者占比最高（26.45%）;患者的治疗方式以靶向、免疫治疗为主（68.03%）。患者共出现1 146例药物相关不良反应,主要涉及抗肿瘤药物,其中15例为治疗当日处理的药物相关不良反应,另外1 131例为患者在院外发生的药物相关不良反应。2023年1月优化日间治疗住院全流程后（分时段诊疗）,与2022年相比患者入院后平均等候时间缩短了26.89%,床位使用率提高了9.09%,患者满意度提高到98.98%。2023年全年的日间治疗爽约率1.15%,日间治疗当日取消率4.39%...     

手术室实施泌尿外科日间手术模式的探讨

目的 探讨医院手术室实施泌尿外科日间手术模式的流程和管理.方法 总结四川大学华西医院泌尿外科日间手术的手术安排和管理流程及手术室的管理模式,对比日间手术实施前后手术室使用效率的相关数据.结果 手术室实施泌尿外科日间手术模式9个月中,顺利完成日间手术504例.泌尿外科手术总台次较往年同期增长849例,手术量增长明显,手术室平均开放时间从(9.03±0.58) h增加到(10.15±0.63 )h,手术室的利用率得到了提高.结论 在手术室开展泌尿外科日间手术可以更有效地利用现有的人力物力,整合手术资源,提高手术室的利用率,加快患者的周转,节约空间和手术成本.同时,患者能得到更专科化的手术配合和护理,更能保证患者的安全.     

日间手术在单纯性白内障手术患者中的应用

目的探讨日间手术应用于白内障手术患者的效果,为临床白内障手术选择最优的手术方式提供依据。方法选取单眼单纯白内障患者160例采用随机数字表法随机分为日间手术组和住院手术组各80例,日间手术组患者在门诊完成术前检查,约定手术时间入院并行手术,24h内出院回家休养,住院手术组患者住院后完成术前检查等待安排手术,手术后观察几天无异常即可出院,比较两组患者术前待床天数、住院天数及医疗费用情况。结果住院手术组术前待床天数为18．0d,日间手术组为1．2d;住院手术组住院时间为（5．15±1．36）d,日间手术组为（1．00±0．00）d,差异有统计学意义（t=27．286,P〈0．01）;住院手术组医疗费用为（6901．72±392．43）元,大于日间手术组的（6499．13±134．05）元,差异有统计学意义（t=8．683,P〈0．01）。结论单纯性白内障手术采用日间手术的方式,能降低医疗费用,缩短住院时间,可作为首选治疗方式。     

Concept of the Ambulatory Pain Physician

Purpose of Review

Given the growing number of ambulatory surgeries being performed and the variability in postoperative pain requirements, early discharge, and inconsistent follow-up, ambulatory surgery presents a unique challenge for this patient population and warrants the presence of an ambulatory pain specialist to evaluate a patient preoperatively and postoperatively to optimize patient safety and satisfaction. This article explores the crucial role that a dedicated pain physician would have in the ambulatory surgery setting.

Recent Findings

The prevalence of chronic pain, opioid use, and substance abuse is growing in this country, while ambulatory and same-day surgery have also experienced considerable growth. Inevitably, more patients with challenging chronic pain or substance abuse are having ambulatory surgery. Increased BMI, advanced age, more comorbidities warranting a higher ASA physical status classification, and longer surgeries are now all components of ambulatory surgery that contribute to increased risk too. Certain surgeries including breast surgery, inguinal hernia repair, and thoracotomy are at higher risk for the conversion of acute to chronic pain, and an ambulatory pain specialist would be beneficial for added focus on these patients.

Summary

Multimodal pain control with non-opioids and regional anesthesia adjuvants are beneficial, while emphasis on a patient’s functional capacity may be more useful than quantifying the severity of pain. Despite the best efforts of patients’ primary care providers or surgeons, patients often are discharged with more chronic opioid therapy than they presented with, and an ambulatory pain specialist can help manage the complications and prevent further escalation of this opioid epidemic. An onsite anesthesiologist with interest in pain management in each ambulatory surgery center administering anesthesia and available onsite to deal with immediate preoperative, intraoperative, and recovery room would be ideal to curb and manage complication from uncontrolled pain and related pain issues.

     

Postoperative Voiding Criteria for Ambulatory Surgery Patients

The number and types of surgeries being performed in ambulatory surgery facilities have increased during the past several years. Many surgeries that were once performed on an inpatient basis routinely occur in outpatient settings today.Patients are required to meet certain discharge requirements and, occasionally, voiding is included in this criteria. Requiring patients to void postoperatively, however, can unnecessarily delay a patient's discharge and contribute to increased anxiety for the patient.This article provides a case study with discussion, a literature review regarding postoperative voiding and urinary retention in ambulatory surgery, and recommendations for future research regarding postoperative voiding criteria for low-risk outpatients. AORN J 89 (May 2009) 871-874. © AORN, Inc, 2009.     

老年日间手术患者延续护理需求现状及影响因素研究

目的 调查老年日间手术患者的延续护理需求现状,并分析其影响因素。方法 2020年11月—12月,采用便利抽样法选取上海市2所三级甲等医院的289例老年日间手术患者作为调查对象,采用一般资料调查表、老年日间手术患者延续护理需求评估问卷对其进行调查。结果 老年日间手术患者对延续护理的需求程度较高,得分为（88.92±14.59）分。其中,各维度的需求得分按条目均分从高到低依次为：健康教育需求、医疗沟通与支持需求、服务方式需求、社会支持需求、心理护理需求。合并其他疾病种类、家庭人均月收入、婚姻状况、就诊科室是延续护理需求情况的影响因素（P<0.05）。结论 老年日间手术患者对延续护理的需求程度较高,其需求情况受多种因素影响。护理人员应基于患者的实际需求,完善延续护理方案,从而为不同特征的老年日间手术患者提供针对性的延续护理服务。     

脊柱微创经皮椎间孔镜日间手术全程化管理模式的构建与效果评价

目的:探讨脊柱微创经皮椎间孔镜日间手术全程化管理模式的构建与效果.方法:选取2017年3月1日～2018年3月31日行经皮椎间孔镜下髓核摘除术的94例腰椎间盘突出症患者作为对照组,采取常规住院管理模式.选取2018年4月1日～2019年4月30日行经皮椎间孔镜下髓核摘除术日间手术的88例腰椎间盘突出症患者作为日间组,实...     

Research Article: Determinants of ambulatory ability after hip fracture surgery in Japan and the USA

We examined the relationship of the length of stay and the day of initiating partial weight bearing to patients' level of ambulatory ability at 3 months after hip fracture surgery in Japan and the USA. The participants were patients aged ≥ 65 years who had undergone hip fracture surgery between August 2005 and September 2007. The data were collected from three hospitals in Japan and two hospitals in the USA. The participants received questionnaires pertaining to patient health outcomes after discharge. One‐hundred‐and‐forty‐nine patients in Japan and 88 patients in the USA completed the questionnaire. In Japan, the length of stay before surgery was longer and partial weight bearing after surgery was initiated later, compared to the USA. This independently predicted a lower level of ambulatory ability at 3 months after surgery. Assessing the reasons for delaying surgery and partial weight bearing is important in Japan. Encouraging ambulation with weight bearing at the earliest possible time is essential for patients to maintain their ambulatory ability after hip fracture surgery. Prospective studies using a large sample and/or intervention studies are required to determine the causal effect on ambulatory ability.     

Ambulatory anesthesia in surgical practice in children

A brief historical overview of the stages of development of outpatient surgery and anesthesiology is provided. It displays features of pre-selection and evaluation of patients for pediatric ambulatory surgery, the relation to the problems of preoperative fasting, anesthesia with concomitant diseases, the relative and absolute contraindications to outpatient surgeries in children. The research discusses the need and form of administration of sedative drugs in premedication in children of different ages, their influence on the recovery time after anesthesia. Compares methods of induction and maintenance of anesthesia, the possible use of volatile and intravenous anesthetics in ambulatory surgery in children, the advantages and disadvantages of given methods, as well as options for their combination with regional blocks. Pays attention to the postoperative analgesia and control of postoperative nausea and vomiting, consider their side effects.     

Patient anxiety and patient satisfaction in hospital-based and freestanding ambulatory surgery centers

The study examined differences in patient anxiety and patient satisfaction between patients who experienced surgery at a hospital-based ambulatory surgery center versus a freestanding ambulatory surgery center. Forty-seven participants completed the State Trait Anxiety Inventory and Press Ganey Ambulatory Surgery Survey. Patients at both types of facilities experienced moderate levels of preoperative anxiety and were highly satisfied with care received. No significant differences were found in preoperative anxiety, overall satisfaction with care, or overall satisfaction with nursing care. The site where the surgery was performed may not be a determining factor in patient anxiety or satisfaction levels.