Watkins W D
Clinical Trials Program, Anesthesiology/CCM, University of Pittsburgh Medical Center, USA.
Acta Anaesthesiol Scand Suppl. 1997;111:113-5.
The importance of the changing health care climate has triggered important changes in the management of high-cost components of acute care facilities. By integrating and better managing various elements of the surgical process, health care institutions are able to rationally trim costs while maintaining high-quality services. The leadership that physicians can provide is crucial to the success of this undertaking (1). The importance of the use of primary data related to patient throughput and related resources should be strongly emphasized, for only when such data are converted to INFORMATION of functional value can participating healthcare personnel be reasonably expected to anticipate and respond to varying clinical demands with ever-limited resources. Despite the claims of specific commercial vendors, no single product will likely be sufficient to significantly change the perioperative process to the degree or for the duration demanded by healthcare reform. The most effective approach to achieving safety, cost-effectiveness, and predictable process in the realm of Surgical Services will occur by appropriate application of the "best of breed" contributions of: (a) medical/patient safety practice/oversight; (b) information technology; (c) contemporary management; and (d) innovative and functional cost-accounting methodology. S "modified activity-based cost accounting method" can serve as the basis for acquiring true direct-cost information related to the perioperative process. The proposed overall management strategy emphasizes process and feedback, rather than specific product, and although imposing initial demands and change on the traditional hospital setting, can advance the strongest competitive position in perioperative services. This comprehensive approach comprises a functional basis for important bench-marking activities among multiple surgical services. An active, comparative process of this type is of paramount importance in emphasizing patient care and safety as the highest priority while changing the process and cost of perioperative care. Additionally, this approach objectively defines the surgical process in terms by which the impact of new treatments, drugs, devices and process changes can be assessed rationally.
不断变化的医疗保健环境的重要性引发了急性护理设施高成本组成部分管理方面的重大变革。通过整合并更好地管理手术过程的各个要素，医疗机构能够在保持高质量服务的同时合理削减成本。医生能够提供的领导力对于这项事业的成功至关重要（1）。应大力强调使用与患者流量及相关资源相关的原始数据的重要性，因为只有当这些数据转化为具有功能价值的信息时，才能够合理地期望参与其中的医护人员以有限的资源来预测并应对不断变化的临床需求。尽管有特定商业供应商的宣称，但没有单一产品可能足以将围手术期流程显著改变到医疗改革所要求的程度或时长。在外科服务领域实现安全、成本效益和可预测流程的最有效方法将通过适当应用以下“最佳实践”来实现：（a）医疗/患者安全实践/监督；（b）信息技术；（c）当代管理；以及（d）创新且实用的成本核算方法。一种“改进的基于活动的成本核算方法”可作为获取与围手术期流程相关的真实直接成本信息的基础。所提议的总体管理策略强调流程和反馈，而非特定产品，并且尽管会给传统医院环境带来初始要求和变革，但能够在围手术期服务中提升最强的竞争地位。这种综合方法构成了多个外科服务之间重要基准活动的功能基础。在改变围手术期护理的流程和成本的同时，这种积极的、比较性的过程对于将患者护理和安全作为最高优先事项至关重要。此外，这种方法客观地定义了手术流程，据此可以合理评估新治疗方法、药物、设备和流程变化的影响。
