ABSTRACT
Introducción: Existen limitaciones en la coordinación entre los niveles primario y secundario de salud en el proceso quirúrgico ambulatorio y de corta estadía, lo que repercute en la calidad del servicio. Objetivo: Diseñar una propuesta de modelo asistencial para el perfeccionamiento del proceso de atención al paciente en cirugía mayor ambulatoria y cirugía de corta estadía. Métodos: Se desarrolló una investigación prospectiva descriptiva del 3 de septiembre de 2012 al 20 de marzo de 2018. En su diseño fueron empleados la modelación y el sistémico-estructural fundamentalmente. Se aplicaron encuestas a expertos con experiencia en los niveles primario y secundario de salud para evaluar la calidad y pertinencia del modelo propuesto. También fueron encuestados los jefes de los grupos provinciales de Cirugía General y Medicina Familiar. Se realizaron entrevistas grupales a clientes del proyecto de investigación (del que se deriva) y a decisores institucionales y del nivel provincial. Fue empleada la técnica de triangulación metodológica y de fuentes. Resultados: La estructuración del modelo partió de la coordinación del trabajo asistencial y metodológico entre los niveles primario y secundario de salud. Se sustentó en cuatro pilares: preparación teórica del personal de salud, observancia de normas de relación en el contexto laboral, cumplimiento de procedimientos en el contexto asistencial y evaluación continua de la calidad asistencial. Los expertos, clientes y decisores avalaron su calidad, pertinencia y posibilidades de implementación. Conclusiones: El modelo presenta calidad, es pertinente y su aplicación es factible(AU)
Introduction: There are limitations in the coordination between the primary and secondary health levels in the outpatient and short-stay surgical processes, which affects the quality of the service. Objective: Designing a proposal for a healthcare model for the improvement of the patient care process in major outpatient surgery and short-stay surgery. Methods: A descriptive and prospective research was carried out from September 3, 2012 to March 20, 2018. Its design involved essentially modeling and the systemic-structural method. Surveys were applied to experts with experience in primary and secondary health levels, in order to assess the quality and relevance of the proposed model. The heads of the provincial groups of General Surgery and Family Medicine were also surveyed. Group interviews were conducted with clients of the research project (from which it is derived) and with institutional and provincial decision-makers. The methodological and source triangulation technique was used. Results: The structuring of the model started from the coordination of the care and methodological work between the primary and secondary health levels. It was based on four pillars: theoretical training of health personnel, observance of relationship rules in the work context, compliance with procedures in the care context, and continuous assessment of the quality of care. The experts, clients and decision-makers recognized its quality, relevance and possibilities of implementation. Conclusions: The model presents quality, is pertinent and its application is feasible(AU)
Subject(s)
Humans , Quality of Health Care , Ambulatory Surgical Procedures/methods , Patient Care/methods , Delivery of Health CareABSTRACT
Abstract Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2-9 days; mean 3.32) preprotocol to a median of 2 days (range 2-3 days; mean 2.16) postprotocol (p< 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p= 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.
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Objective To evaluate the feasibility,security and efficiency of general anaesthesia compared with regional anaesthesia for minimally-invasive thyroid surgery(MITS)with short-stay discharge.Methods 103 cases undergoing MITS with short-stay discharge from Jan.2013 to Jun.2013 in Fuzhou General Hospital were collected.54 patients were operated under regional anaesthesia and 49 under general anaesthesia.All variables of patients including demographic characteristics,vital signs (blood pressure,heart rate,blood glucose) during the operation,duration and type of operation,postoperative complications,difficulty in airway management and anesthesia consumption were recorded and analyzed.Results There was no difference in respect to level of blood glucose,length of hospital stay,discharge time,patient or operator satisfaction rate,anesthesia or operation complications rate between the two groups.Blood pressure (T1:(90 ± 7.0) vs (79 ± 8.3) mmHg,T2:(88 ± 6.8) vs (80 ±7.6) mmHg,P ＜0.05) and heart rate(T1:(130 ± 18.2) vs(101 ± 12.0)/min,T2:(120 ± 19.7) vs(103 ± 13.3)/min,P ＜ 0.05)level were higher,while the recovery time of anesthesia((0.3 ± 0.14)vs(0.8 ± 0.35)h,P ＜ 0.05)) and anesthesia consumption ((1350 ± 78) vs (2580 ± 220) yuan,P ＜ 0.05)) were lower in the regional anaesthesia group compared with those in the general anaesthesia group.Conclusions Both general anaesthesia and regional anaesthesia for MITS with short-stay discharge are safe and effective.General anesthesia has less psychological trauma,while regional anaesthesia has shorter recovery time and lower anesthetic consumption.
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Objetivo: Demostrar las bondades del impacto, tiempo y costo-eficacia de la cirugía de corta estancia en sábados, domingos y días festivos. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, observacional, comparativo. Análisis estadístico: Prueba t de Student, chi cuadrada y análisis costo-eficacia. Material y método: Durante 4 años se realizaron 1,200 cirugías dentro de este programa piloto, utilizando la capacidad hospitalaria instalada y al mismo personal contratado para la atención médica de dichos días, sin contar con una unidad de cirugía de corta estancia como tal. Los procedimientos realizados fueron: plastía inguinal, resección de enfermedad pilonidal, plastía umbilical, resección de tumor benigno de partes blandas, plastía de pared, mastectomía subcutánea, hemorroidectomía, fistulectomía y excisión de tumores benignos mamarios y se comparó con los mismos procedimientos, pero realizados en forma de cirugía programada, evaluando y comparando las siguientes variables: edad, género, procedimiento realizado, tiempo de estancia hospitalaria y costo-beneficio del procedimiento. También se evaluó necesidad de hospitalización, reingreso en menos de 24 h, morbilidad y mortalidad. Resultados: Los diagnósticos incluyeron: hernias inguinales con 486 casos, tumores de partes blandas en 359 casos, hernia umbilical en 185 casos, eventración en 88 casos, enfermedad anorrectal en 27 casos, enfermedad pilonidal en 17 casos, ginecomastia en 17 casos, fimosis en 10 y otros en 11. Se realizaron plastía inguinal, resección de enfermedad pilonidal, plastía umbilical, excisión de tumor benigno de partes blandas, plastía de pared, mastectomía subcutánea, hemorroidectomía y/o fistulectomía, circuncisión y otros. El tiempo empleado para el manejo quirúrgico se redujo de 36 horas en promedio a doce horas (p < 0.05). El costo-eficacia fue del 40% menor en comparación con los pacientes que se operaron con el método tradicional. El promedio de tiempo quirúrgico y anestésico no fue diferente entre cirugía ambulatoria y el método tradicional. Conclusión: Se puede realizar con gran eficiencia cirugía de corta estancia en sábados domingos y días festivos con un ahorro de 40%.
Objective: To demonstrate the benefits of the impact, time, and cost-effectiveness of short stay surgery performed on weekends and holidays. Setting: General Hospital of Mexico (Third level health care hospital). Design: Prospective, cross-sectional, observational, and comparative study. Statistical analysis: Student's t test, chi square, and cost-effectiveness analysis. Material and method: During 4 years, 1,200 surgeries were performed within this pilot program, using the installed hospital infrastructure and the same personnel employed for medical care in those days, without having a special short stay surgery unit as such. Performed procedures were: inguinal plasty, resection of pilonidal disease, umbilical plasty, resection of benign soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy, fistulectomy, and excision of benign breast tumors, these were compared with the same procedures but performed as programmed surgeries. We assessed and compared the following variables: age, gender, performed procedure, time of hospital stay, and cost-benefit of the procedure. We also evaluated the need of hospitalization, re-admittance in less than 24 h, morbidity and mortality. Results: Diagnoses included: inguinal hernias with 486 cases, 359 cases of soft tissue tumors, 185 cases of umbilical hernia, 88 cases of eventration, 22 cases of anorectal disease, 17 cases of pilonidal disease, 17 cases of gynecomastia, 10 cases of phimosis, and 11 other diagnoses. We performed inguinal plasties, resection of pilonidal disease, umbilical plasty, excision of soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy and/or fistulectomy, circumcision and other procedures. The time used for surgical management was reduced from an average of 36 to 12 hours (p < 0.05). Cost-effectiveness was 40% lower as compared with the traditional method. Surgical and anesthetic times were not different between ambulatory and traditional surgeries. Conclusion: Short stay surgery can be performed efficiently on the weekends and holydays with a 40% savings.