基于加速康复外科的市级医院日间手术评价指标体系研究  

Study on monitoring index system concerning day surgery based on enhanced recovery after surgery in municipal hospitals

作　　者：成月佳 沈兵 李群[3] 陈敏[4] 郑悦 余松轩 侯冷晨 CHENG Yuejia;SHEN Bing;LI Qun;CHEN Min;ZHENG Yue;YU Songxuan;HOU Lengchen(Department of Medical Affairs,Shanghai Chest Hospital/Shanghai Jiao Tong University School of Medicine Affiliated Chest Hospital,Shanghai 200030,P.R.China;Department of Medical Business,Shanghai Shenkang Hospital Development Center,Shanghai 200041,P.R.China;Department of Medical Affairs,Shanghai General Hospital,Shanghai 201600,P.R.China;Department of Information,Children’s Hospital of Shanghai/Children’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200062,P.R.China)

机构地区：[1]上海市胸科医院·上海交通大学医学院附属胸科医院医务部,上海200030 [2]上海申康医院发展中心医疗事业部,上海200041 [3]上海市第一人民医院医务部,上海201600 [4]上海市儿童医院·上海交通大学附属儿童医院信息部,上海200062

出　　处：《华西医学》2023年第2期214-219,共6页West China Medical Journal

基　　金：上海申康医院发展中心临床科技创新项目(SHDC12021639);上海申康医院发展中心管理研究项目(2022SKMR-37)。

摘　　要：目的 依据上海市级医院开展日间手术现况,建立基于加速康复外科(enhanced recovery after surgery, ERAS)的日间手术“结构-过程-结果”评价指标体系。方法 选择2019年—2021年上海36家市级医院开展的短病程手术患者的病案首页数据。分析日间手术开展情况,确定日间手术规范化管理的适宜病种和手术目录。基于ERAS理念建立结构型质量、过程型质量、结果型质量“三维质量”的评价体系。结果 在国家推荐的日间手术目录中,上海市级医院于2019年—2021年共开展87种,另有开展手术量小于100例的术式81种。经3轮专家论证,共确定了54项指标,包括34项“过程指标”和20项“结局指标”。涵盖术前(含院前)指标17项,术中指标20项,术后指标13项。结论 2019年—2021年上海市级医院开展日间手术范围逐年扩展,手术量逐年递增,但整体上日间手术服务能力有待提高。“结构-过程-结果”指标为实现对多学科的参与度、ERAS关键点的覆盖程度、全诊疗过程的规范化程度进行评价、提升日间手术内涵质量,提供了科学依据。Objective To establish a set of structure-process-outcome(SPO) indicators associating with the enhanced recovery after surgery(ERAS) process in day surgeries, based on the current data from Shanghai municipal hospitals. Methods The data on the first page of medical records of patients undergoing short-course surgery in 36municipal hospitals in Shanghai between 2019 and 2021 were selected. The development of day surgery was analyzed, and the appropriate diseases and surgical catalogue for standardized management of day surgery were determined. Based on ERAS, the three-dimensional integrated indicators combined SPO process were designed. Results According to the national recommended day surgery directory, there were 87 kinds of day surgeries caried out by Shanghai municipal hospitals during 2019-2021. Another 81 kinds of day surgeries recommend had less than 100 cases. Under the circumstances, a set of SPO indicators were established, including 34 process indicators and 20 outcome indicators. They covered all process of day surgery. Conclusions An increase of day surgery is observed from 2019 to 2021 among Shanghai municipal hospitals. But the surgical ability still needs improving. The application of SPO indicators would provide evidence to enhance evaluation on how multi-disciplinary treatment and ERAS are conducted among day surgeries, therefore estimating if the surgical process is standard and methodical.

关 键 词：日间手术 加速康复外科 结构-过程-结果评价指标 

分 类 号：R197.32[医药卫生—卫生事业管理]