The experience of improving the satisfaction of patients in ophthalmic day surgery based on the whole-process management mode
基于全流程管理模式下提高眼科日间手术患者满意度的体会

摘要

随着DRG付费模式的运行，眼科大部分患者将实行日间手术模式。日间手术是指将既往手术患者需要在院治疗多日的住院模式，通过优化诊断与治疗流程以及围手术期实施加速康复外科（enhanced recovery after surgery，ERAS）策略，转变为能在1日（24 h）内完成入院、手术及出院流程的医疗服务模式[1]。发展日间手术服务模式有利于降低社会医疗成本、缓解医疗资源紧张，优化患者就医流程，提高群众满意度。随着麻醉学及外科技术的发展，尤其是微创手术的广泛开展和围手术期管理理念的进步，日间手术服务模式和理念已被广泛接受。我院眼科患者门诊就诊时通过医生评估，符合日间手术条件者在院前完善术前检查，预约手术日期，手术当天到日间病房住院并手术，术后经主刀医师或主管医师观察后，当日或次日即可出院。该模式让患者住院便捷、且节约医疗资源。但同时也因为住院时间短，医护与患者接触时间仅几个小时，且在有限的时间内还需完成入院评估、术前沟通、手术、出院手续等一系列事项，导致医患沟通不充分，患者就医体验差，满意度低。而患者满意度是优化公立医院绩效考核体系，提升医疗服务质量和水平的重要考核指标，故提高日间手术患者满意度有重要的意义。为提高患者就医体验和满意度，我科采取了优化日间手术流程，丰富健康教育形式，改进日间手术护理记录单，做好随访延续性护理等措施，患者满意度得分由改善前83.70±13.438提高到改善后的95.91±10.658，且差异有统计学意义（P<0.05），此次质量改进活动提高了患者满意度，改善了患者就医体验。

Abstract

With the operation of the DRG payment model, most patients in ophthalmology will implement the daytime surgery mode. Day surgery refers to the hospitalization mode in which patients need to be treated in hospital for several days by optimizing the diagnosis and treatment process and implementing accelerated rehabilitation surgery (enhanced recovery after surgery, ERAS) strategy in the perioperative period to complete the admission, surgery and discharge process within 1 day (24 h). The development of day surgery service mode is conducive to reducing social medical costs, alleviating the shortage of medical resources, optimizing the medical process of patients, and improving the satisfaction of the masses. With the development of anesthesiology and surgical techniques, especially the extensive development of minimally invasive surgery and the progress of perioperative management concept, the service mode and concept of day surgery have been widely accepted. When the outpatient department of our hospital passes the doctor's evaluation, those who meet the conditions of day surgery should improve the preoperative examination before the hospital, make an appointment for the operation date, and be hospitalized in the day ward on the day of the surgery. After the surgeon or the chief physician, they can be discharged on the same day or the next day. This mode makes it convenient for patients to be hospitalized and save medical resources. However, at the same time, due to the short hospitalization time, the contact time between medical care and patients is only a few hours, and a series of matters such as admission evaluation, preoperative communication, surgery, and discharge procedures are completed within the limited time, resulting in insufficient doctor-patient communication, poor medical experience, and low satisfaction. Patient satisfaction is an important assessment index to optimize the performance appraisal system of public hospitals and improve the quality and level of medical service, so it is of great significance to improve the satisfaction of patients in day surgery. In order to improve patients 'medical experience and satisfaction, our department has optimized the daytime surgery process, enriched the forms of health education, improved daytime surgery nursing records, and provided follow-up continuity care, etc. The patient satisfaction score increased from 83.70 ± 13.438 to 95.91 ± 10.658, and the difference was statistically significant (P <0.05). This quality improvement activity improved patient satisfaction and improved patients' medical experience.