Author/Editor		Rems, Miran; Dolžan Lindič, Helena; Kunčič Mandelc, Judita
Title		Ponovni sprejemi po operaciji v dnevnem oddleku kot kazalec kakovosti
Translated title		Readmission after day surgery as a quality indicator
Type		članek
Vol. and No.		Letnik 24, št. 5
Publication year		2008
Volume		str. 173-178
ISSN		1318-2927 - Asian philosophy
Language		slv
Abstract		Izhodišča. Jutranji sprejem in odpust zvečer nudi bolniku, ki potrebuje kirurški poseg, hitro vrnitev v domače okolje. Operativni poseg in celotni potek zdravljenja mora potekati v prej dogovorjenem protokolu, klinični poti, ki tak hiter proces omogoča. Podaljšanje hospitalizacije preko noči in ponovni sprejemi predstavljajo odklon. Delež le-teh pri zdravljenju se zaradi tega lahko smatra kot kazalec kakovosti zdravstvene oskrbe. Metoda. Zdravljenje vseh bolnikov na dnevnem oddelku se od ustanovitve oddelka oktobra 2003 spremlja prospektivno. Vsi posegi se protokolirajo s klinično potjo. Po odpustu so anketirani vsi bolniki po istem vprašalniku. Odkloni se zabeležijo ne glede na to, ali potrebujejo ponovni sprejem ali ne. Rezultati. V letu 2006 in 2007 smo na Dnevnem oddelku Splošne bolnišnice Jesenice zdravili 1926 kirurških bolnikov. Najpogostejši so bili artoskopski posegi v kolenu, operacije dimeljskih kil, odstranitve osteosintetskega materiala in ostale operacije. Podaljšano je bilo hospitaliziranih 91 (4,7 %) bolnikov. Glavni vzroki so bili daljši posegi z dreniranjem, podaljšano delovanje bloka in slabost po posegu. Zaradi socialnih vzrokov je bilo premeščenih 5 bolnikov, 2 pa zaradi prevelike oddaljenosti. Po odpustu je 49 (2,5 %) bolnikov potrebovalo dodatni ambulantni obisk pri svojem zdravniku ali operaterju, od tega je bilo 5 (0,2 %) bolnikov ponovno sprejetih. Skupno je potrebovalo 4,9 % bolnikov premestitev na oddelek ali ponovni sprejem. Zaključki. Delo v dnevnem oddelku poteka po predhodno dogovorjenih protokolih in kliničnih poteh, ki jih vodi koordinatorica primerov. Delež bolnikov, ki potrebujejo podaljšanje hospitalizacije ali ponovni sprejem po dopustu, je primerljiv z objavljenimi podatki. Dodatno standardiziranje postopkov bo zmanjševalo delež premestitev in ponovnih sprejemov.Background. Morning admission and evening discharge is advantageous for the surgical patients due to fast return to home care. To achieve such fast procedures all care must follow defined protocols and clinical pathways. With protocols all discrepancies can be avoided in most cases. The percentage of admission after day surgery and readmission, as a discrepancy from the protocol can therefore be seen as a quality indicator. Methods. Data for all patients in day surgery were collected prospectively from the opening of day surgery in October 2003. All admitted patients were treated according to clinical pathways and all discrepancies were recorded. Results. In years 2006 and 2007 in day surgery department of General hospital Jesenice 1926 patients were surgically treated. Knee arthroscopic procedures were the most frequent ones, followed by inguinal hernia, removal of ostheosynthetic material and other operative procedures. On the day of the procedure 91 (4,7 %) patients were admitted to the night ward. Main reasons for admittance were long surgery, prolonged spinal blockade and nausea. Five patients were admitted because of the social reasons and two because of the long distance from home. After discharge 49 (2,5 %) needed an additional outpatient visit by the surgeon or general practitioner and 3 (0,15 %) patients were readmitted. All together, 4,8 % of patients needed admission after operation or readmission after discharge. Conclusions. Care in day surgery department is guided by the clinical pathways and managed by the nurse, case manager. The percentage of the patients, who need admittance after surgery, is comparable with other published data. Additional standardization of the procedures and processes could lead to lower percentage of admittance and readmitance after day surgery.
Keywords		dnevna kirurgija klinična pot zaplet kazalnik kakovosti day surgery clinical pathway complication quality indicators