ABSTRACT
New models in clinical management seek a clinical practice based on quality, efficacy and efficiency, avoiding variability and improvisation. In this paper we have developed one of the most frequent clinical processes in our speciality, the process based on DRG 311 or transurethral procedures without complications. Along it we will describe its components: Stabilization form, clinical trajectory, cost calculation, and finally the process flowchart.
Subject(s)
Delivery of Health Care/organization & administration , Hospital Departments/organization & administration , Models, Organizational , Urology/organization & administrationABSTRACT
OBJECTIVES: To create an innovative process to care for urological outpatient surgery patients in an outpatient clinic basis conducted by nursing staff. METHODS: Our centre covers a population of 153,266 inhabitants. A differentiated process for urological outpatient surgery patients has been implemented, conducted by nursing staff trained for the attendance of urologic patients ("phimosis","short penile frenulum",and "vasectomy request" sent from Primary Care units). Planning and implementation phases have been carried out. In the control phase, a questionnaire was given after surgical procedures with 9 different items, in order to assess different issues of the process. RESULTS: A total of 224 patients were attended during the study period, and 175 valid questionnaires were collected (78.1%). The procedures performed were circumcision (11.7%), frenuloplasty (14.6%), and vasectomy (73.7%), with a median patient age of 36 years. Satisfaction level was high for all items of the questionnaire, with 98.2% of patients" very satisfied" or "rather satisfied" when asked for the overall quality of attention of the whole process. The lowest scores were obtained in items that assessed delay from the appointment to attendance date (5.1% of patients "little satisfaction or not satisfied"), and the perception of information supplied (2.3% "little satisfaction or not satisfied"). A lower satisfaction score was observed (in the delay from appointment to attendance) in younger patients (p=0.001) and in patients who underwent circumcision (p=0.004). No complaints with regard to this process were collected. No incorrect indications for interventions were observed. CONCLUSIONS: The attendance of urological outpatient surgery patients can be safely and effectively performed by nursing staff trained for the care of urologic patients, without observing a decrease of the level of user satisfaction. Focusing on a process strategy allows the identification of areas for improvement and makes possible total quality management.
Subject(s)
Ambulatory Surgical Procedures/methods , Urologic Surgical Procedures/methods , Adolescent , Adult , Age Factors , Aged , Ambulatory Surgical Procedures/legislation & jurisprudence , Female , Humans , Legislation, Medical , Male , Middle Aged , Nurses , Patient Care Planning , Patient Satisfaction , Quality Control , Spain , Urologic Surgical Procedures/legislation & jurisprudence , Young AdultABSTRACT
OBJETIVO: Creación de un proceso pionero de atención a la patología urológica quirúrgica ambulatoria en consultas externas, conducida por el personal de enfermería. MÉTODOS: Nuestro centro presta servicio a 153.266 habitantes. Se ha implementado un subproceso diferenciado para la consulta de patología urológica quirúrgica ambulatoria (fimosis, frenillo corto, o solicitud de vasectomía citados desde Atención Primaria), conducido por personal de enfermería entrenado en el paciente urológico. Se han llevado a cabo las fases de planificación e implementación. Para la fase de control se administró un cuestionario de satisfacción tras la intervención con evaluación de 9 aspectos diferentes del proceso. RESULTADOS: De un total de 224 pacientes atendidos en el periodo del estudio, se recopilaron 175 cuestionarios válidos para el análisis (78,1%). Las intervenciones realizadas fueron circuncisión (11,7%), frenulectomía (14,6%), y vasectomía (73,7%), con una mediana de edad de 36 años. El nivel de satisfacción fue elevado para todos los items del cuestionario, con un 98,2% de los pacientes muy satisfecho o bastante satisfecho en la atención global del proceso. Las puntuaciones más bajas se obtuvieron en las preguntas que evaluaron la demora desde la citación hasta la atención en consulta (5,1% de los pacientes poco o nada satisfechos), y en la que evaluó la percepción del nivel de información suministrado (2,3% poco o nada satisfechos).Se encontró una menor satisfacción (con la demora desde la citación hasta la atención) en los pacientes más jóvenes (p=0,001) y en los sometidos a circuncisión (p=0,004). No se registraron reclamaciones con respecto a este proceso, ni se observaron indicaciones quirúrgicas incorrectas. CONCLUSIONES: La atención en consulta externa del paciente con patología urológica quirúrgica ambulante puede ser realizada, de modo eficaz y seguro, por personal de enfermería entrenado en el paciente urológico sin apreciar disminución en el nivel de satisfacción del usuario. El enfoque de gestión por procesos permite la identificación de áreas de mejora y hacer posible la gestión de la calidad total (AU)
OBJECTIVES: To create an innovative process to care for urological outpatient surgery patients in an outpatient clinic basis conducted by nursing staff. METHODS: Our centre covers a population of 153,266 inhabitants. A differentiated process for urological outpatient surgery patients has been implemented, conducted by nursing staff trained for the attendance of urologic patients (phimosis,short penile frenulum, and vasectomy request sent from Primary Care units). Planning and implementation phases have been carried out. In the control phase, a questionnaire was given after surgical procedures with 9 different items, in order to assess different issues of the process. RESULTS: A total of 224 patients were attended during the study period, and 175 valid questionnaires were collected (78.1%). The procedures performed were circumcision (11.7%), frenuloplasty (14.6%), and vasectomy (73.7%), with a median patient age of 36 years. Satisfaction level was high for all items of the questionnaire, with 98.2% of patients very satisfied or rather satisfied when asked for the overall quality of attention of the whole process. The lowest scores were obtained in items that assessed delay from the appointment to attendance date (5.1% of patients little satisfaction or not satisfied), and the perception of information supplied (2.3% little satisfaction or not satisfied). A lower satisfaction score was observed (in the delay from appointment to attendance) in younger patients (p=0.001) and in patients who underwent circumcision (p=0.004). No complaints with regard to this process were collected. No incorrect indications for interventions were observed. CONCLUSIONS: The attendance of urological outpatient surgery patients can be safely and effectively performed by nursing staff trained for the care of urologic patients, without observing a decrease of the level of user satisfaction. Focusing on a process strategy allows the identification of areas for improvement and makes possible total quality management (AU)