Zhongshan Hospital is a top comprehensive hospital in China, and for years it had been difficult for a patient to receive hospitalized treatment or undergo an operation at the hospital. This problem remained despite the efforts made by various parties and there were still a great number of patients waiting to receive operations at our hospital. Meanwhile, new minimally invasive techniques, esp. laparoscope and endoscope, had been developing rapidly and our hospital was in want of specialists in the related areas and necessary equipment, which had greatly hampered the development of the above mentioned disciplines. In addition, our hospital and departments were obliged to shorten the average hospital stay and the average expenditure in response to patients’ needs. In order to improve such situation, the Surgery Day-Time Ward was founded by Zhongshan Hospital. The initial plan included: an exclusive area with operation rooms; prioritization of departments that face mounting pressure of too many patients on the waiting list (such as general surgery, urology, and endoscope centre); breaking down departmental barriers and building an interdisciplinary ward; a double-down reform model of business procedures and position setting. With deliberate planning and sufficient preparation, the Surgery Day-Time Ward was officially set up and started to operate in November 2009.
The Surgery Day-Time Ward is on the 15th Floor, Building No.1 of the Inpatient Department, Zhongshan Hospital. The old operation rooms were refurbished and divided into two areas: Inpatient Area and Day-Time Operation Area. There’re 50 general hospital beds and 4 A-Type hospital beds, that is, 54 beds in total for surgical departments. General surgery, urology surgery and orthopedics respectively occupy 28, 10 and 10 beds. Six beds are reserved for thoracic surgery, otolaryngology, department of gynecology and obstetrics, orthopedics and other departments. The Day-Time Operation Area has four operation rooms. In terms of staff members, a general surgery expert with experience in medical management is appointed as director of the Surgery Day-Time Ward. A nursing team is responsible for nursing services in the whole ward. Departments with fixed beds at the Surgery Day-Time Ward should assign doctors and physicians to assist in work and sit on duty at the Ward and take turns on a monthly basis. According to the requirement that one doctor is responsible for five beds, the general surgery, urology surgery, and orthopedics should send 6, 2, and 2 physicians respectively.
The daily operation of the Surgery Day-Time Ward conforms to the following rules. The director is in charge of daily affairs of the Ward and allocation of medical resources. All clinical departments enact their own regulations, deploy their hospital beds, and manage physicians and medical workers who belong to them. All departments are held responsible for medical safety and healthcare quality. The Nursing team sees to the nursing of all patients in the Ward. The Medical Affairs Department administers vertically and is responsible for overall coordination at the initial stage, and supervision on a long-term basis. In collaboration with the Information and Network Department, the Medical Affairs Department has set up an information managing and monitoring platform that sorts data of the area, shares business data reports and provides evaluation and guidance on improvement of working efficiency to all departments. In terms of patients’ reception, the Surgery Day-Time Ward only accepts patients who need invasive treatment. Patients’ health conditions should be well enough to undergo day-time operation, with no cardiopulmonary illnesses or other serious complications. Normally, patients are under the age of 75, and are expected to be free from symptoms such as massive hemorrhage, respiratory obstruction, severe post-operative pains, etc. The rank of operations conducted is normally Grade Two or Grade Three, with occasional cases of Grade Four. Before hospitalization, there should be a diagnosis of the illness and patients should have completed the majority of auxiliary examinations. Patients can be discharged from the hospital within 24 hours after the operation. Those in peculiar conditions and those who have been hospitalized for more than 3 days must be moved to wards of relevant departments. The Surgery Day-Time Ward constantly improves the Pre-Operation Notification and Post-Operation Follow-Up Visit Mechanism.
The Surgery Day-Time Ward has been operating with increasing standardization and efficiency thanks to the comprehensive competitiveness and strength of Zhongshan Hospital. In 2015, the Surgery Day-Time Ward treated more than 6400 patient times and more than 4600 in 2010, with an average hospital stay of approximately 2.3 days. To some extent, the Surgery Day-Time Ward has alleviated the problem of immense difficulty to receive hospitalized treatment and operations in Zhongshan Hospital, and has played a positive role in increasing hospitalization capacity, the number of patients who can receive operations and medical revenue, updating types of diseases, shortening average days of hospital stay, modifying medical insurance indices, as well as strengthening the general competitiveness of Zhongshan Hospital in the medical market. An increase in the number of hospital beds has enabled all departments to update disease types in their own wards, which would further facilitate their discipline development. The Surgery Day-Time Ward has also played its part in supporting the establishment of new disciplines such as the Endoscopy Centre ( which has now set up its own wards). In the meantime, young practitioners are given more opportunities to participate in operations so that they can perform less difficult/relatively easier operations on their own as soon as possible. The Surgery Day-Time Ward also accumulates educational resources of common diseases and frequently-occurring diseases, which is conducive to training of resident doctors and specialist physicians. Surgery day-time operations have standardized classification of grades of operations, which simplifies the management of operation and anaesthetization. Operations that require nursing care of the same standard will get homogenized services and it has eased the working pressure of nurses and benefited the path management of clinical practices.
Smooth operation of the Surgery Day-Time Ward partly alleviates the contradiction between the growing demands of operations and hospitalizations, and is therefore welcome by patients. The Surgery Day-Time Ward has effectively contributed to enrichment of medical, pedagogical, and scientific research resources and improving management of Zhongshan Hospital in general. Increasing workload brings more income to department members, and serves as an incentive to generate working enthusiasm and a joint force of teamwork. The establishment of the Surgery Day-Time Ward has so far achieved an all-win situation in that the hospital, departments and patients all benefited from it. In breaking down the management barriers of different specialties, the Surgery Day-Time Ward has explored the operation mode and managerial experience of “An inpatient area of mixed-specialties treatment”.