Search

Empirical study on the response policy to COVID-19 epidemic based on the new public management theory: take the emergency department rescue area of West China Hospital of Sichuan University as an example

With the change of COVID-19, the prevention and control of COVID-19 infection epidemic entered a new stage in December 2022. How to quickly complete the emergency treatment of a large number of patients in a short period of time, and ensure that patients in emergency department can get rapid and effective medical treatment has always been an urgent problem that emergency department need to solve. The Department of Emergency Medicine of West China Hospital of Sichuan University has adopted patient-oriented management measures based on the core idea of the new public management theory, and has achieved remarkable results. Therefore, this article summarizes the workflow and nursing management strategies of the emergency department rescue area of West China Hospital of Sichuan University in dealing with the batch treatment of COVID-19 infected patients, including optimizing and correcting the environment layout of the ward, implementing the “secondary triage” mode in the rescue area, adding an inter-hospital referral platform for critical patients with COVID-19 emergency, building a conventional COVID-19 reserve material repository in the emergency department, setting up a field office for multi-department joint emergency admission service, optimizing emergency transport services for patients with COVID-19, scientific scheduling and reasonable human resource management, and providing humanistic care for employees, in order to provide reference for the management practice of the emergency department.

Fast Track Guideline for Colorectal Surgery of West China Hospital in Sichuan University (2)

３ 整体流程图……

Drug single dose distribution optimization information

摘要:目的:优化药品单剂量调剂,加强信息化管理,优化操作流程。 方法:采用东华软件:住院药房管理系统(DTCISIP)和住院药品调剂系统(DTCISID) 实施。结果:东华软件成功实现了我院4300病床的药品单剂量调剂及各部门管理联网,优化了操作系统及流程,且系统运行稳定。结论:东华软件进行药品单剂量调剂,加强了药品的出入管理,优化了药品单剂量调剂的操作流程。Abstract: Objective: To improve united dose dispension, enhance the utilization of information technology in management of united dose dispension and optimize clinical human resource. Methods: DONG HUA software, which included DTCISIP system(system for management of medicine for inpatients) and DTCISID system(system for dispension of medicine for in-patients), was used to carry out united dose dispension. Results: United dose dispension of 4300 beds were easy to achieve by using DONG HUA software. The system worked smoothly and received lots of praise. Conclusion: The management of medicine is enhanced and clinical human resource is optimized by using DONG HUA software to carry out united dose dispension

心胸外科危重患者院内转运流程探讨

【摘要】　目的　总结并完善心胸外科危重患者院内转运流程。　方法　2007年1月-2009年12月将16名危重患者按院内转运流程安全转至外科重症监护病房（ICU）。　结果　实现危重患者安全转运，为患者病情的特别监护和后续治疗赢得时间和时机。　结论　危重患者院内转运流程在实际工作中发挥了重要作用，制订和实施严谨、有序、高效的流程方案是提高危重患者院内转运成功率的关键。

Fast Track Guideline for Colorectal Surgery of West China Hospital in Sichuan University

Clinical Effects of Postoperative Restrict Rehydration on Different Body Mass Index of Patients with Colorectal Cancer

Objective To explore the clinical effects of postoperative restrict rehydration on different body mass index (BMI) of patients with colorectal cancer. Methods From January 2008 to January 2009, the patients diagnosed definitely as colorectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different BMI (underweight group, normal group, overweight group).Results The first defecation time, aerofluxus time and ambulation time of the fluid restriction group were significantly earlier than those of the tradition therapy group (Plt;0.05), and postoperative in-hospital time was also less (Plt;0.05). However, the differences of early postoperative rehabilitation among underweight group, normal group and overweight group in the tradition therapy group and fluid restriction group had no statistical significance (Pgt;0.05). The complications such as pulmonary infection, anastomotic leakage, intestinal obstruction and wound dehiscence in the fluid restriction group were significantly lower than those in the tradition therapy group (Plt;0.05). In the tradition therapy group, the incidences of anastomotic leakage and wound dehiscence in overweight group were significantly higher than those in the underweight and normal group (Plt;0.05). The rate of postoperative complications among underweight group, normal group and overweight group in the fluid restriction group had no statistical significance (Pgt;0.05). Conclusion Postoperative restrict rehydration for overweight colorectal cancer patients has a good clinical effect, which can promote the early postoperative rehabilitation.

Influence of Different Emergency Reception and Triage Workflows between Wenchuan and Lushan Earthquakes on the Victim’s Length of Stay in Emergency Department

Objective　To explore the influence of two emergency reception and triages workflows between Wenchuan and Lushan earthquakes on the victim’s length of stay in emergency department of the West China Hospital of Sichuan University. Methods　A total of 65 victims admitted in the West China Hospital within 12 hours after Lushan earthquake were retrospectively analyzed, and their diagnosis and treatment information and the length of stay in emergency department were collected and compared with those of the victims in Wenchuan earthquake. Then we analyzed the influence of two emergency reception and triage workflows on the length of stay of the batches of earthquake victims. Results　For the Lushan earthquake victims, the median length of stay in the emergency reception and triage workflow was 0.51 hour, while that was 2.13 hours for the Wenchuan earthquake victims, with a significant difference (Plt;0.05). Conclusion　The emergency reception and triage workflow for Lushan earthquake victims is a summarized experience and improvement based on that for Wenchuan earthquake, which can be used as references for treating batches of victims in the emergency department after a disaster.

Completion Rate of Fast Track Items in Postoperative Management of Colorectal Cancer Surgery: What Are The Impacts?

Objective To discuss the impacts of completion rate of fast track items on postoperative management of colorectal cancer surgery. Methods Between February 2010 and May 2010, 100 patients (Group “Year 2010”) were analyzed retrospectively, who were compared with 76 patients (Group “Year 2008”) from the same period of 2008. Postoperative recovery indexes, complications, and completion rate of fast track items were studied and compared. Results For major fast track items, the completion rates of restrict rehydration, early out-of-bed mobilization, early oral intaking, and management of gastric tube and drains were significantly higher in Group “Year 2010” than those in Group “Year 2008” (Plt;0.05). Meanwhile, the completion rate of urinary catheter management was significantly higher in Group “Year 2008” than that in Group “Year 2010” (Plt;0.05). In early rehabilitation, the first flatus of patients in Group “Year 2010” 〔(3.86±1.05) d〕 was significantly earlier than that in Group “Year 2008” 〔(4.28±1.22) d〕, Plt;0.05; for postoperative hospital stay, though, there was no statistically significant difference between two groups (Pgt;0.05). As to the complications, there was also no statistically significant difference between two groups (Pgt;0.05). Conclusions As the concepts of fast track surgery became increasingly favorable, completion rates of fast track items are increased. As a result, more and more fast track items turn into regular perioperative care. Although enhanced recovery has been achieved, better collaboration and localilzation are still needed to make the full advantage of fast track surgery.

Clinical Effect of Restrict Rehydration Strategy on Elderly Patients with Colorectal Cancer in Fast-Track

Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.

Enhanced Lung Rehabilitation after Surgery: Peri-operative Processes Optimization Is Necessary

The concept of "enhanced recovery after surgery (ERAS)" has been well known by care providers. Implementation of the ERAS principles requires minimally invasive surgical technology in conjunction with multidisciplinary teamwork. Only if these two aspects of peri-operative care regime optimization and "all-in-one model in medical" care were linked up associatelly, ERAS could be realized. Thoracoscopic surgery was a milestone in thoracic surgery. The successful application of such a recovery program requires the foundation of pain and risk free ward in perioperative period and improving quality of life post discharge. This review summarizes the peri-operative regimen care optimization regarding the utility of ERAS in the VATS lobectomy of patients with lung cancer. The first one is preoperative evaluation issues. It involves conditioning the patient and implementing a pre-operative exercise and a physical therapy regimen. The second one is operative and individual anesthetic maneuvers and the selective use of tube in the post-operative period. The third one is the foundation of pain and risk free ward:what are methods optimum of post operative management? The fourth one is medical management of patient's outcomes and the ERAS regimen continuing optimum. The fifth one is the importance of function of multi-departmental coordination in ERAS.