School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
Hong Kong Med J. 2011 Dec;17(6):441-5.
To assess the utilisation rate of a preoperative assessment clinic and its impact on length of stay and discharge destinations.
Retrospective case series with internal comparisons.
A tertiary hospital in Hong Kong.
All medical records of elective surgical admissions to a hospital in Hong Kong from April to June 2008 were retrieved. Medical records of patients who did not attend the preoperative assessment clinic were further reviewed by surgeons to assess if the patients could have been referred to the clinic.
Total length of stay, preoperative and postoperative length of stay, and the discharge destinations of the patients attending and not attending the clinic were compared. RESULTS. In all, 640 patients underwent elective operations, of whom 22 (3%) patients were seen in the preoperative assessment clinic. In patients who had a major operation, the mean (standard deviation) total length of stays for clinic attenders and non-attenders were: 5.2 (3.6) versus 13.2 (18.8) days (P<0.001). The respective figures for preoperative and postoperative length of stay were: 1.3 (2.3) versus 4.5 (8.9) days (P=0.001), and 3.9 (2.9) versus 8.7 (14.5) days (P<0.001). For patients who had an intermediate operation, the respective mean (standard deviation) length of hospital stays were 2.4 (2.0) versus 7.3 (13.9) days (P=0.002) and the figures for postoperative length of stays were 1.3 (0.5) versus 4.5 (9.3) days (P=0.001). Surgeons had classified 108 (17%) of the cases as possible preoperative assessment clinic users. Among the latter, 71 (66%) had no special reason to stay in the hospital. The discharge destination was not associated with the use of preoperative assessment clinic for patients having major (Chi squared=0.18, P=0.912) or intermediate (Chi squared=0.34, P=0.468) operations.
Successful implementation of preoperative assessment clinic service requires close collaboration between surgeons, anaesthetists, clinicians, and also the re-engineering of health service delivery.
评估术前评估诊所的利用率及其对住院时间和出院去向的影响。
香港一家三级医院的回顾性病例系列，内部比较。
香港一家医院的择期手术入院的所有病历均被检索。进一步由外科医生审查未参加术前评估诊所的患者的病历，以评估患者是否可以转诊至诊所。
比较参加和未参加诊所的患者的总住院时间、术前和术后住院时间以及出院去向。
共有 640 名患者接受了择期手术，其中 22 名（3%）患者在术前评估诊所就诊。在接受大手术的患者中，就诊者和未就诊者的平均（标准差）总住院时间分别为：5.2（3.6）天与 13.2（18.8）天（P<0.001）。术前和术后住院时间的相应数据分别为：1.3（2.3）天与 4.5（8.9）天（P=0.001）和 3.9（2.9）天与 8.7（14.5）天（P<0.001）。对于接受中等手术的患者，相应的平均（标准差）住院时间分别为 2.4（2.0）天与 7.3（13.9）天（P=0.002）和术后住院时间分别为 1.3（0.5）天与 4.5（9.3）天（P=0.001）。外科医生将 108 例（17%）病例归类为可能的术前评估诊所使用者。在后者中，71 例（66%）没有特殊理由住院。对于接受大手术（卡方=0.18，P=0.912）或中手术（卡方=0.34，P=0.468）的患者，其出院去向与术前评估诊所的使用无关。
成功实施术前评估诊所服务需要外科医生、麻醉师、临床医生之间的密切合作，还需要对医疗服务的提供方式进行重新设计。
Zotero 插件