现代医疗的门诊手术趋势

Oleg I. Nechaev
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摘要

背景。门诊手术被证明是有效的,但在组织门诊手术中心的工作流程、选择病人和开发围手术期护理系统方面还存在一些问题。目的研究创建门诊手术中心的国际经验。方法和材料。采用系统综述和荟萃分析报告指南(PRISMA)编写综述。结果。门诊手术的发展阶段定义如下:首先是小手术,然后是局部麻醉下的手术,最后是全身麻醉下的腹腔镜手术。现代外科手术提供了广泛的干预措施,禁忌症极少。此外,目前还不清楚门诊手术服务应该在多学科医院、门诊手术中心还是门诊和综合诊所机构内提供。治疗过程应通过全面的教育、标准化的流程以及对康复和出院设定明确的预期来吸引患者。当已经接受过手术治疗的复杂患者来到门诊机构时,正确选择患者至关重要。确定病人是否适合接受外科手术治疗并没有既定的程序,病人的选择取决于多种因素。门诊手术中心面临着成本增加、吸引和留住合格员工等诸多挑战。答案可能是根据绩效支付费用,并关注与患者相关的指标。病人出院后的健康状况评估首先是通过电话进行的,然后是通过信使,现在则是通过数字云应用程序。
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Outpatient Surgery Trend in Modern Healthcare
Background. Outpatient surgery is proven to be effective, but there are some issues in organizing the workflow of an outpatient surgery center, selecting patients, and developing a perioperative care system. Purpose. To study the international experience in creating outpatient surgery centers. Methods and Materials. The review was prepared using the reporting guidelines for systematic reviews and meta-analyses (PRISMA). Results. The stages of an outpatient surgery development were defined as follows: firstly, minor surgery, then surgery under local anesthesia, and finally, laparoscopic surgery under general anesthesia. Modern surgery provides a wide range of interventions with minimal contraindications. In addition, it’s still unclear whether outpatient surgery services should be delivered within a multidisciplinary hospital, an outpatient surgery center, or an outpatient and polyclinic institution. Treatment process should engage patients by giving a comprehensive education, standardizing processes, and setting clear expectations for recovery and discharge. When complex patients who have already undergone a surgical intervention come to an outpatient institution, it is crucial to correctly select them. There is no established process of determining whether a patient is suitable for a surgical intervention; patient selection depends on multiple factors. Outpatient surgery centers face several challenges like increasing costs, attracting and retaining of qualified staff. The answer could be to provide payments based on performance, and to focus on patient relevant indicators. The assessment of patient’s health condition after discharge is done, firstly, via telephones, then through messengers, and now by digital cloud applications.
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