Re-engineering the elective surgical service of a tertiary hospital: a historical controlled trial
Re-engineering the elective surgical service of a tertiary hospital: a historical controlled trial
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DOI：
10.5694/j.1326-5377.1998.tb140247.x
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发表时间：
1998-09-07
影响因子：
11.4
通讯作者：
Noble, S
中科院分区：
文献类型：
--
作者：
Caplan, GA;Brown, A;Noble, S
目的：研究重组择期手术相关流程的临床效果。设计：一项前瞻性的历史对照试验。对照组为1995年3月至1996年1月，干预后患者为1996年2月至1996年10月。单位：一所大型教学三级医院(悉尼威尔斯亲王医院)。患者：224例(介入前123例，介入后101例)，均住在当地。干预：介绍一套包括入院前评估教育、手术当天入院、出院后急诊护理的外科服务。主要观察指标：住院时间、手术并发症、疼痛评分和患者满意度。结果：干预后干预组患者发生一种或多种并发症的风险降低(干预后与对照组比较：25.7%比38.2%；相对风险[RR]，0.66；95%可信区间[CI]，0.44-0.98；P=0.035)，因为伤口感染风险降低(5.0%比16.3%；RR，0.3%；95%CI，0.12~0.78；P=0.0075)。其他并发症(围手术期或术后)和疼痛评分没有变化。接受重组服务的患者住院时间显著缩短，对术前和出院后护理的满意度较高，并且更有可能再次接受相同的治疗(92.9%vs82.6%；P=0.037)。结论：重组的外科服务伴随着住院时间的减少，不会导致护理的恶化，但可能会减少术后并发症，提高患者满意度。
Objective: To study the clinical effects of re-engineering the processes associated with elective surgery.Design: A prospective, historical controlled trial. Control patients were enrolled from March 1995 to January 1996, and postintervention patients from February 1996 to October 1996.Setting: A major teaching, tertiary care hospital (Prince of Wales Hospital, Sydney).Patients: 224 patients (123 before and 101 after the intervention) undergoing elective herniorrhaphy or laparoscopic cholecystectomy who lived in the local area.Intervention: Introduction of a re-engineered surgical service consisting of preadmission assessment and education, admission on day of surgery, and postacute care after discharge. There were no changes to the operative methods or infection control procedures.Main outcome measures: Length of stay, operative complications, pain scores and patient satisfaction.Results: The risk of a patient suffering one or more complications was reduced in the postintervention group (postintervention v. control patients: 25.7% v. 38.2%; relative risk [RR], 0.66; 95% confidence interval [CI], 0.44-0.98; P=0.035) because of a reduced risk of wound infections (5.0% v. 16.3%; RR, 0.30; 95% CI, 0.12-0.78; P=0.0075). Other complications (perioperative or postoperative) and pain scores were unchanged. Patients treated by the re-engineered service had a significantly shorter length of stay, reported a higher level of satisfaction with the preoperative and postdischarge care, and were more likely to say that they would have the same treatment again (92.9% v 82.6%; P=0.037).Conclusions: Re-engineering surgical services, with an associated reduction in length of stay, does not lead to a deterioration in care and may decrease postoperative complications and increase patient satisfaction.