持续质量改进在降低妇科日间手术当日取消率中的应用  

Application of continuous quality improvement in reducing same-day cancellation rate of gynecological day surgery

作　　者：杨玉琼 李明轩[1,2] 谭欣 YANG Yuqiong;LI Mingxuan;TAN Xin(Department of Day Surgery Nursing,West China Second University Hospital,Sichuan University,Chengdu,Sichuan 610066,P.R.China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu,Sichuan 610041,P.R.China;Department of Day Surgery,West China Second University Hospital,Sichuan University,Chengdu,Sichuan 610066,P.R.China;Department of Day Surgery,Hi-Tech Zone Hospital for Women and Children,West China Second University Hospital,Sichuan University,Chengdu,Sichuan 610095,P.R.China)

机构地区：[1]四川大学华西第二医院日间手术护理单元,成都610066 [2]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西第二医院日间手术部,成都610066 [4]四川大学华西第二医院高新妇女儿童医院/成都高新区妇女儿童医院(成都高新区妇幼保健院)日间手术部,成都610095

出　　处：《华西医学》2025年第2期245-249,共5页West China Medical Journal

摘　　要：目的探究降低妇科日间手术当日取消率的对策。方法调查分析四川大学华西第二医院日间手术部2021年1月—12月(改进前)妇科日间手术当日取消的情况,从患者自身因素、医疗因素、检查因素进行原因分析,针对其中可控因素制订并实施管理对策及持续质量改进,2022年9月—2023年1月(改进后)再次收集妇科日间手术当日取消的情况,比较改进前后妇科日间手术当日取消率。结果针对日间手术“患者就诊时间与预排程时间间隔太近”“患者术前检查顺序不合理”“医生对白带异常患者的治疗不规范”这3项原因进行了持续质量改进,改进前后妇科日间手术当日取消率分别为3.70%(156/4211)和2.13%(30/1411),差异有统计学意义(χ^(2)=8.231,P=0.004)。结论优化的术前检查及入院流程、有效的术前宣教和医患沟通、统一的白带检查审批标准及治疗规范、明确的术前综合评估门诊岗位职责及监管制度是降低妇科日间手术当日取消率的有效措施。Objective To explore strategies to reduce the same-day cancellation rate of gynecological day surgery.Methods The same-day cancellation status of gynecological surgery in the Department of Day Surgery,West China Second University Hospital,Sichuan University from January to December 2021(before improvement)was investigated.The causes of cancellation were analyzed from three aspects:patient-related factors,medical factors,and examination factors.Subsequently,management countermeasures were formulated for the controllable factors and continuous quality improvement was implemented.After improvement,the same-day cancellation rate of gynecological day surgery from September 2022 to January 2023 was collected and compared with that before improvement.Results Continuous quality improvement was implemented targeting three factors in day surgery,namely the short interval between patient’s visit time and pre-scheduled time,the irrational sequence of preoperative examinations for patients,and the non-standardized treatment of patients with abnormal vaginal discharge by physicians.The same-day cancellation rates of gynecological day surgery before and after the continuous quality improvement were 3.70%(156/4211)and 2.13%(30/1411),respectively,and the difference was statistically significant(χ^(2)=8.231,P=0.004).Conclusion Optimizing the preoperative examination and admission process,effective preoperative education and physician-patient communication,establishing unified standards for the approval of vaginal discharge tests and standardized treatment protocols,and clarifying the responsibilities of the preoperative comprehensive assessment outpatient clinic along with the supervision system are effective measures to reduce the same-day cancellation rate of gynecological day surgery.

关 键 词：日间手术 妇科 手术取消 原因分析 持续质量改进 

分 类 号：R473.71[医药卫生—护理学]