On November 23, 2022, the National Health Commission issued the "Interim Provisions on the Management of Day Medical Quality in Medical Institutions" ( hereinafter referred to as the "Regulations" ).
According to data from the National Health Commission, in 2021, about 70% of tertiary public hospitals carried out day surgery , making useful explorations on efforts to shorten the waiting time for patients' hospitalization and surgery, improve the efficiency of medical services, and alleviate the problems of "difficulty in hospitalization" and "difficulty in surgery".
Among them, the proportion of day surgery performed in Zhejiang and Shanghai is significantly higher than that in other provinces. Benchmark hospitals represented by Central South University Xiangya Hospital , Sichuan University West China Hospital , Shanghai Jiaotong University School of Medicine, , etc. have appeared in various places.
Since the original National Health and Family Planning Commission issued the "Notice on Issuing the Action Plan for Further Improving Medical Services" ( Guowei Medical Fa [2015] No. 2 ), the day medical model represented by day surgery has been promoted to a national medical policy.
notice pointed out that under the conditions of minimally invasive surgery and anesthesia support, the hospital chose medium- and small-scale elective surgery with clear diagnosis, clear clinical pathway, and controllable risks, and gradually implemented day surgery.
After that, in the documents on the comprehensive reform of public hospitals, "day surgery" frequently appeared.
The National Health Commission has successively formulated a series of documents such as recommended diseases during day surgery and operating specifications for surgical types of diseases during day surgery. In February 2022, the "Recommended Catalog of Day Surgery by the General Office of the National Health Commission (2022 Edition )" involved 708 surgical procedures.
But there are also hidden worries behind the rapid development: lacks unified standards for the quality management of day care, resulting in uneven quality and safety of daily care in various medical institutions, which not only poses medical quality and safety risks, but also is not conducive to the healthy development of day care.
( see the report "DRG payment can save money for hospitals and raise salary for doctors! Where is the "card" for day surgery model promotion?")
"Everyone is struggling and is still relatively rough in system construction at present." Liu Weidong, director of the Day Surgery Center of Xiangya Hospital of Central South University ( hereinafter referred to as " Xiangya Hospital " ) told the health community in this way.
Chairman of the Anesthesiology Society of Chinese Medical Association and Professor of Anesthesiology at Peking Union Medical College Hospital Huang Yuguang told the health community that the "Regulations" have a clear guiding and guiding role in the implementation of day care by medical institutions across the country, and ensure the quality and safety of day care by strengthening process supervision.
How to maintain the bottom line of medical quality and safety?
Ensure medical quality and safety is the top priority of medical institutions, and the same is true for day care.
So, what is the difficulty in day medical quality management?
"Compared with the traditional medical model, day medical care has faster turnover and more uncertain factors. We often face 'encounter battles'." Huang Yuguang, as vice chairman of the China Day Surgery Cooperation Alliance, learned that many hospitals are currently carrying out day medical care, but there is great arbitrary and blindness, and there are potential risks.
"The organizational form, diagnosis and treatment process, operating conditions of each hospital are very different." Huang Yuguang said that there are some safety hazards here, which can also be called "the imperfect status" , or "the lack of quality" .
Daily medical treatment can reduce the time and cost of hospitalization for patients. "But while improving efficiency, how to ensure that medical quality cannot be reduced is a contradiction." Huang Yuguang told the health definition that it is necessary to make a comprehensive balance while improving quality and efficiency.
In addition, in medical institutions, anesthesiology department, which belongs to high-risk departments, is a platform that supports the efficient operation model of day surgery. He said that during this process, if the quality of medical care is sacrificed for the efficiency of the surgery and "if there are too many radishes, there will be big problems."
Huang Yuguang believes that it is very necessary to introduce relevant regulations at the current national level, which is conducive to better standardizing industry behavior and maintaining the bottom line of patient safety.
is timely. The "Regulations" are issued to improve the daily medical quality management system from the aspects of organization and operation management, quality control, supervision and management, and formulate a series of management systems such as disease selection system, department and doctor authorization management system, patient evaluation system, patient follow-up system, quality monitoring and evaluation system, emergency management system, information security and information disclosure system, and training system.
These systems cover all aspects of day medical patients before hospitalization, during hospitalization, after discharge, as well as related elements such as disease types, technology, doctors, etc., providing basic guidelines for medical institutions to carry out day medical quality management.
With the popularization of day medical care, more and more departments will be involved, such as ophthalmology, otolaryngology, obstetrics and gynecology, basic surgery, urology, orthopedics, etc.
"So many departments have their own focus and ideas from their respective professional perspectives. A mechanism is needed to let everyone think from their perspectives and build consensus, so that they can cooperate and win-win cooperation." Huang Yuguang said.
This also shows that day care needs more policy guidance, guiding the hospital to establish a special organizational structure to communicate and coordinate multidisciplinary teams.
Article 5 of the "Regulations" states that hospitals, maternal and child health hospitals and specialized disease prevention and control institutions that carry out day medical care should have a special organization for day medical quality management under the Medical Quality Management Committee, which is composed of relevant management personnel such as medical management, quality control, nursing, medical insurance, hospital infections, medical records, information, and clinical professionals with senior technical qualifications.
Medical quality management must rely on data to make it well-founded and continuously improved. The "Regulations" require that medical institutions strengthen data collection, analysis and feedback on day medical care; establish a mechanism to collect and analyze the occurrence of day medical quality ( safety ) and adverse events; establish a day medical emergency plan, and improve consultation and referral mechanisms, etc.
These controversial points about day medical care
Have you encountered it in the hospital?
Liu Weidong's feeling after reading the "Regulations" is that the document can clarify the general confusion and controversial points of medical institutions in the current practice, "it is obviously formulated based on practical exploration, which is quite consistent with reality."
Previously, without the framework of day medical quality management, various hospitals explored in combination with the characteristics of day medical care and condensed some basic principles, but also encountered some problems.
"This day medical document first hits the finale of a generally controversial issue." Liu Weidong told the health community.
, different regions and even different hospitals across the country have been called day surgery, and the standards are different. "Some places are based on 24 hours, some places are 48 hours, and some places are even 72 hours." he introduced.
The "Regulations" propose that day medical care is a medical service model that completes the full-process diagnosis and treatment services within 24 hours and is an integral part of the hospitalization service.
There are two main concepts that can be clarified:
1. Day-care patients are hospitalized patients, not outpatients;
2. It is limited to complete full-process diagnosis and treatment services such as admission, surgery, and discharge within 24 hours.
"This establishes a common measurement standard for domestic hospitals to compare day care." Liu Weidong believes that in addition, the "Regulations" also determine the basic principles and organizational structure of day care quality management, which should be connected with inpatient service quality management.
According to the "National Third-Level Public Hospital Performance Assessment Operation Manual (2022 Edition )", day surgery refers to the patient entering and being discharged from the hospital within 24 hours according to the diagnosis and treatment plan. If the patient needs to be postponed for hospitalization due to the condition, the hospital stay will not exceed 48 hours.
What kind of patients are suitable for day surgery? It is also a very controversial issue.
Traditional hospitalization treatment is to first undergo hospitalization examination and then determine the diagnosis and treatment plan. According to the "Regulations", day medical care should complete patient selection, diagnosis and treatment plan formulation, appointment and pre-hospital education before hospitalization.
Liu Weidong believes that the regulation is equivalent to setting a threshold for day medical care. This means that if a medical institution cannot complete the selection of patients and the formulation of diagnosis and treatment plans for certain diseases before hospitalization, it will not be able to carry out day-to-day diagnosis and treatment of the disease.
This objectively limits that medical institutions should do their best and blocks some risks brought about by forcibly carrying out day care.
Does daily medical treatment be discussed before surgery? It is also a point of great controversy among the medical institutions currently underway.
The "Regulations" state that day medical records should include the homepage of hospitalization records, admission and discharge records within 24 hours, preoperative discussion conclusions, surgery/treatment records, surgical safety verification records, surgical inventory records, various informed consent forms, medical orders, auxiliary examination and testing reports, body temperature sheets, nursing records sheets, and medical documents and materials related to this diagnosis and treatment completed before admission.
"'Pre-operative discussion conclusion', the wording is very good." Liu Weidong commented.
He introduced that all surgical patients must have preoperative discussions, which is a basic requirement of the 18 core systems. The preoperative discussion of ordinary hospitalized patients needs to reflect the process, such as participants, discussion time, condition introduction, speech, etc., and finally the discussion conclusion.
From the perspective of day medical care, high-quality medical services provide more patients, while non-medical work should be simplified and work efficiency should be improved. Therefore, the wording of "preoperative discussion of conclusions" means that the process can be simplified and focuses on the conclusions.
is in line with the 18 core medical systems, and takes into account the characteristics of day medical care.
"The file has made clear to the areas that are generally controversial. This will naturally play a leading and standardized role in the development of day medical care nationwide." Liu Weidong told the definition of health. Can
alleviate the supply and demand contradiction in public hospitals?
Reform of medical insurance payment methods, medical insurance flight inspections, audits and inspections of large hospitals. The current requirements facing public hospitals are stricter than each other, and it is imperative to improve the operation and management level of public hospitals.
Experts believe that under such a background, further standardizing the promotion of day surgery medical care may inject new impetus into the high-quality development of hospitals.
Huang Yuguang introduced that the national number of surgeries is about 60 million to 70 million units a year, and the current contradiction between supply and demand of medical resources still exists. Most hospitals cannot meet the needs of surgical patients for timely hospitalization, and it is still normal for patients to wait for hospitalization, wait for surgery, and wait for anesthesia.
Therefore, hospitals are required to improve service quality, reduce complications, reduce the average hospitalization day of , and shorten the time for patients to wait for beds and medical treatment under the premise of safe medical treatment. Huang Yuguang told the health definition, "From now on the future, day care is the right time to take root and sprout, and the branches will be deep and lush."
"In recent years, in the performance appraisal of third-level public hospitals, the country has regarded the proportion of day surgery to elective surgery as a hard indicator for hospital assessment, which has given it a new driving force." Liu Weidong introduced that with the launch of the reform of DRG/DIP payment method, day care has ushered in new development opportunities.
Nowadays, under the logic of DRG/DIP payment method reform, medical behavior is undergoing a reshaping.Liu Weidong introduced that in some developed countries abroad, day care, like DRG, is also produced and developed in the context of hospital cost control.
Because it also contains the internal logic of cost control, the reform of DRG/DIP payment method is consistent with the existence of day care.
Under the logic of DRG, medical institutions of the same level within the same geographical scope and the payment for treating the same disease is certain, and the treatment cost is lower than this amount, which will become the balance of the hospital.
Liu Weidong gave an example with the health industry. The average hospitalization day for a disease is about 7 days. In the day medical mode, only 24 hours are required, so the patient's bed fees, nursing fees, and some non-medical expenses have decreased. As hospital spending decreases, surplus increases.
In this way, hospitals have stronger motivation to control medical expenses and costs, and will also prefer the new service model of day medical care, which has obvious cost-control effects.
Liu Weidong introduced that Xiangya Hospital will start the reform of DRG/DIP payment method on New Year's Day 2023, with only one month left.
At that time, will the development of day medical care be taken to a higher level? The health industry will also continue to pay attention to the exploration and successful cases of hospitals in various places. All pioneers are welcome to provide clues to the health industry. Produced by
Health World, reproduction is prohibited without authorization.
If reprinted in violation of regulations, legal responsibility will be pursued!
Author｜Liu Wenyang
Producer｜Zheng Yujun
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