院前管理单元的构建及对手术科室运行效率的影响

doi:10.3761/j.issn.0254-1769.2022.11.013

摘要/Abstract

摘要：

目的探讨构建院前管理单元在手术科室运行中的作用。方法选取2020年9月—2021年3月行早期肝癌切除术、膝关节置换术和髋关节置换术的177例患者作为试验组,由院前管理团队统一进行管理试点,回顾性分析2020年2月—8月同病区同病种接受常规入院流程管理的261例患者作为对照组。分别比较两组同病种患者的平均住院日、术前等待时间、住院费用。结果试验组平均住院日、术前等待时间少于对照组,差异均具有统计学意义（P<0.001）;平均住院费用比较,髋关节置换术患者的平均住院费用试验组低于对照组,差异具有统计学意义（P<0.05）,两组早期肝癌切除术和膝关节置换术患者的平均住院费用比较,差异无统计学意义（均P=0.058）。结论院前管理单元干预能有效提高手术科室的运行效率,促进医疗资源的充分利用,有效缓解医疗资源紧张的现状,缩短患者平均住院日,减少部分病种患者的住院费用。

关键词: 院前管理, 手术科室, 围手术期护理, 护理管理研究

Abstract:

Objective To explore the role of constructing the prehospital management department in the operation of surgical departments. Methods 177 patients who underwent early liver cancer resection,knee replacement and hip replacement from September 2020 to March 2021 were selected as the experimental group. The experiments were conducted by the prehospital management team. 261 patients with the same disease who received the routine admission process from February 2020 to August 2020 were included in the control group. The average preoperative waiting time,length of stay and hospitalization expenses of the 2 groups were compared. Results The average preoperative waiting time and hospital stay in the experimental group were significantly less than those in the control group（P<0.001）. The average hospitalization cost in the experimental group of hip replacement was significantly lower than that in the control group（P<0.05）,but there was no significant difference in the early liver cancer resection and knee replacement between the 2 groups（P=0.058）. Conclusion The intervention of the prehospital management department can apparently improve the efficiency of surgical departments,making full use of medical resources and greatly alleviating the shortage of medical resources. The management mode is worth of promoting.

Key words: Prehospital Management, Surgical Departments, Perioperative Care, Nursing Administration Research

俞申妹, 兰美娟, 金静芬, 封秀琴, 冯佳, 王婷婷. 院前管理单元的构建及对手术科室运行效率的影响[J]. 中华护理杂志, 2022, 57(11): 1366-1370.

YU Shenmei, LAN Meijuan, JIN Jingfen, FENG Xiuqin, FENG Jia, WANG Tingting. The construction of the prehospital management department and its impact on the operation efficiency of surgical departments[J]. Chinese Journal of Nursing, 2022, 57(11): 1366-1370.

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参考文献 15

[1]	吴海霞, 吴茜, 施雁. 国内外肿瘤患者个案管理模式的研究进展[J]. 中华现代护理杂志, 2019, 25(34):4532-4536.
	Wu HX, Wu Q, Shi Y. Research progress on case management model for cancer patients at home and abroad[J]. Chin J Mod Nurs, 2019, 25(34):4532-4536.
[2]	Ang TY, Wang CH, Lin YF, et al. Colorectal cancer in Taiwan:a case-control retrospective analysis of the impact of a case management programme on refusal and discontinuation of treatment[J]. J Adv Nurs, 2018, 74(2):395-406. DOI URL
[3]	安培, 丁焱, 王慧, 等. 妊娠期乳腺癌个案管理方案的制订及实践[J]. 中华护理杂志, 2018, 53(4):433-437.
	An P, Ding Y, Wang H, et al. Formulation and practice of case management plan for breast cancer in pregnancy[J]. Chin J Nurs, 2018, 53(4):433-437.
[4]	司龙妹, 刘飞, 张佩英, 等. 造口患者围手术期健康教育的最佳证据总结[J]. 中华护理杂志, 2021, 56(3):452-457.
	Si LM, Liu F, Zhang PY, et al. Summary of the best evidence of perioperative health education for stoma patients[J]. Chin J Nurs, 2021, 56(3):452-457.
[5]	张凤娟, 祁建明, 陈鸣宇, 等. 预住院管理模式的信息化探索与实践[J]. 中国数字医学, 2020, 15(12):55-58.
	Zhang FJ, Qi JM, Chen MY, et al. Informatization exploration and practice of the pre-hospitalization management mode[J]. Chin Digit Med, 2020, 15(12):55-58.
[6]	Liem IS, Kammerlander C, Suhm N, et al. Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures[J]. Injury, 2013, 44(11):1403-1412. DOI PMID
[7]	梁小芹, 鲁雪梅, 刘均娥, 等. 共管照护模式在老年髋部骨折患者中的研究进展[J]. 中华护理杂志, 2020, 55(10):1484-1489.
	Liang XQ, Lu XM, Liu JE, et al. Research progress on geriatric orthopedic co-management care model in geriatric hip fracture patients[J]. Chin J Nurs, 2020, 55(10):1484-1489.
[8]	李萌, 张旭东, 郭淑岩, 等. 应用Bootstrap-DEA方法的公立三级医院技术效率测量与比较分析[J]. 中国卫生政策研究, 2020, 13(3):64-68.
	Li M, Zhang XD, Guo SY, et al. Measurement and comparative analysis of different technical efficiencies of public tertiary general hospital using Bootstrap-DEA approach[J]. Chin J Heal Policy, 2020, 13(3):64-68.
[9]	黄巧红, 朱同玉. 公立医院运营效率综合评价与分析[J]. 中国卫生质量管理, 2019, 26(6):1-4.
	Huang QH, Zhu TY. Comprehensive evaluation of operation efficiency of public hospitals[J]. Chin Heal Qual Man, 2019, 26(6):1-4.
[10]	巢仰云, 杨玥, 张永勤. 公立医院运营管理的思考与建议[J]. 医学教育管理, 2020, 6(4):391-394.
	Chao YY, Yang Y, Zhang YQ. Thoughts and suggestions on the operation management of public hospitals[J]. Med Educ Man, 2020, 6(4):391-394.
[11]	吕轶娟. 基于卫生经济学理论的医院平均住院日影响因素研究[J]. 现代医院, 2018, 18(5):658-661,665.
	Lü YJ. Research on influencing factors of hospital average length of stay based on health economics[J]. Mod Hosp, 2018, 18(5):658-661,665.
[12]	Forni S, Pieralli F, Sergi A, et al. Mortality after hip fracture in the elderly:the role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients[J]. Arch Gerontol Geriatr, 2016, 66:13-17. DOI URL
[13]	王影新, 刘飞, 张树琪, 等. 乳腺癌个案管理师核心能力评价指标的构建[J]. 中华护理杂志, 2021, 56(3):387-393.
	Wang YX, Liu F, Zhang SQ, et al. Construction of core competency evaluation index system for breast cancer case managers[J]. Chin J Nurs, 2021, 56(3):387-393.
[14]	邓娟, 罗青, 纪玉桂, 等. 脑卒中个案管理师准入标准和工作职责方案的构建[J]. 中华护理杂志, 2020, 55(5):652-658.
	Deng J, Luo Q, Ji YG, et al. Construction of eligibilities and responsibilities for stroke case managers[J]. Chin J Nurs, 2020, 55(5):652-658.
[15]	兰美娟, 宋剑平, 金静芬, 等. 大型综合公立医院护理效率管理实践与探索[J]. 中华医院管理杂志, 2021, 37(4):332-335.
	Lan MJ, Song JP, Jin JF, et al. Practice and exploration of nursing efficiency management in large general public hospitals[J]. Chin J Hosp Man, 2021, 37(4):332-335.