Status of standardized management of ambulatory surgery in China
Objective:To investigate the status and management of ambulatory surgery in medical institutions.Methods:Based on literature review and expert consultation,a self-developed questionnaire was developed.The survey was conducted regarding the institutions,departments,diseases,management model,limiting factors,and indicator monitoring of daytime surgery in medical institutions in China.Results:Of the 380 hospitals that conducted day surgerys,25.3%(96)were the institutions of China Ambulatory Surgery Alliance,51.6%(196)defined by the length of stay within 24 hours,and 48.4%(184)were defined by within 48 hours of hospitalization.Ambulatory surgery was performed in 15 clinical specialties,including general surgery(275,72.4%).The largest number of specialties for day surgery in the surveyed hospitals were 3(13.9%).The top five diseases of day surgery were cataract(36.3%),breast tumor(35.0%),inguinal hernia(21.6%),body surface tumor(19.0%),and uterine tumor(13.9%).Regarding the management model,45.5%(173)used mixed model,41.8%(159)used decentralized management.Among the 7 ambulatory surgery safety and quality control evaluation indicators,the indicators of unplanned readmission rate within 7 days of ambulatory surgery(97.1%),unplanned readmission rate within 30 days of surgery(96.8%)and the number of deaths within 30 days of ambulatory surgery(96.8%)had a detection rate of more than 96.0%,and the remaining indicators had relatively low detection rates.The top 3 factors limiting the performance of ambulatory surgery were high risk of ambulatory surgery(60.3%),lack of support from hospital decision-making level(44.2%),and irrational allocation of performance appraisal(43.2%).Conclusion:The proportion of day surgery carried out in medical institutions is low,and the number of specialties that have day surgery is limited,the diseases are relatively easy to be solved by ambulatory surgery,the quality control is weak,the management model is vague,and the safety needs to be improved.In the future,it is necessary to strengthen the construction of the ambulatory surgery system in medical institutions,the supply side support of medical insurance and management norms,and build a safe,homogeneous and scientific ambulatory surgery diagnosis and treatment environment,constantly improve the technical level and service capacity of ambulatory surgery.
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