Keane Frank, Hammond Laura, Kelliher Gerry, Mealy Ken
National Clinical Programme in Surgery, Department of Surgical Affairs, 121, St Stephens Green, Dublin 2, Ireland.
Ir J Med Sci. 2018 Aug;187(3):747-754. doi: 10.1007/s11845-017-1726-5. Epub 2017 Dec 12.
In the year to July 2017, surgical disciplines accounted for 73% of the total national inpatient and day case waiting list and, of these, day cases accounted for 72%. Their proper classification is therefore important so that patients can be managed and treated in the most suitable and efficient setting.
We set out to sub-classify the different elective surgical day cases treated in Irish public hospitals in order to assess their need to be managed as day cases and the consistency of practice between hospitals.
We analysed all elective day cases that came under the care of surgeons between January 2014 and December 2016 and sub-classified them into those that were (A) true day case surgical procedures; (B) minor surgery or outpatient procedures; (C) gastrointestinal endoscopies; (D) day case, non-surgical interventions and (E) unclassified or having no primary procedure identified.
Of 813,236 day case surgical interventions performed over 3 years, 26% were adjudged to accord with group A, 41% with B, 23% with C, 5% with D and 5% with E. The ratio of A to B procedures did not vary significantly across the range of hospital types. However, there were some notable variations in coding and practices between hospitals.
Our findings show that many day cases should have been performed as outpatient procedures and that there were variations in coding and practices between hospitals that could not be easily explained. Outpatient procedure coding and a better, more consistent, classification of day cases are both required to better manage this group of patients.
截至2017年7月的这一年里，外科专业在全国住院患者和日间手术等候名单中占比73%，其中日间手术占72%。因此，对其进行恰当分类很重要，这样患者才能在最合适、最有效的环境中得到管理和治疗。
我们着手对爱尔兰公立医院接受治疗的不同择期外科日间手术进行细分，以评估它们作为日间手术进行管理的必要性以及各医院之间做法的一致性。
我们分析了2014年1月至2016年12月期间外科医生负责治疗的所有择期日间手术病例，并将其细分为以下几类：(A)真正的日间手术操作；(B)小手术或门诊手术；(C)胃肠内镜检查；(D)日间非手术干预；(E)未分类或未确定主要手术。
在3年期间进行的813,236例日间手术干预中，26%被判定符合A组，41%符合B组，23%符合C组，5%符合D组，5%符合E组。A类与B类手术的比例在不同类型医院中没有显著差异。然而，各医院在编码和做法上存在一些显著差异。
我们的研究结果表明，许多日间手术本应作为门诊手术进行，而且各医院在编码和做法上存在难以轻易解释的差异。需要门诊手术编码以及对日间手术进行更好、更一致的分类，以便更好地管理这组患者。
