Exponemos nuestra experiencia en la gestión de la lista de espera (LEQ) y la actividad de los servicios quirúrgicos, en un hospital grupo 2 del INSALUD. Los objetivos son reducir la demora en LEQ, incrementar la actividad quirúrgica, implantar un sistema de información eficaz y mejorar la gestión de pacientes.
Material y método.Implantación, en agosto de 1998, de nuevas formas de gestión; desde 1999, la Circular 7/97 INSALUD; creación de la UDCA, la UCSI; gestión informática de LEQ; inicio quirófanos (a las 8.30), número intervenciones quirófano/día (> 3), índice ocupación (> 75%), suspensiones (<3%) y programación quirúrgica; asignación mensual de quirófanos, según pacientes en lista, y envío mensual de información a los servicios. El período abarca 5 años (1997-2001).
ResultadosMayor ingreso en LEQ (el 23,98% el 2001 respecto al 2000), intervenciones (7.000/año), intervenciones ambulatorias (el 59,33% en 2001 respecto a 1997) y CMA (59,75%). Hay un 79% de ocupación quirófanos. No existen esperas de más de 6 meses (desde 1998). Menor demora media IMSALUD (27,7 días en 1998; 36,87 en 1999). Suspensiones >3% (desde 1998). Un 88,86% de intervenciones con pacientes de LEQ y un 78,82% de salidas en jornada ordinaria. Menos depuraciones (un 10,90% en 2001). Mayor complejidad (6,66%), peso medio (27,52%) y diagnósticos al alta (50%); disminución del índice de estancia media ajustada (6,66%) y de la estancia media (10,97%) en 2001 respecto a 1997.
ConclusionesMejor gestión de lista de espera quirúrgica al unificarse en una central; la programación quirúrgica debe realizarse en sesiones clínicas, no en consulta; la Normativa del Bloque Quirúrgico aumenta su rendimiento; el nombramiento de un responsable mejora su gestión, y el mejor funcionamiento del hospital y de los servicios quirúrgicos aumenta la demanda.
We describe our experience of the management of surgical waiting lists and activity in the hospital of Ntra Sra. del Prado (a general hospital of the Spanish public health system [INSALUD]). The objectives were to reduce waiting list delays, increase surgical activity, implement an efficient information system, and improve patient management.
Material and methodNew management techniques were introduced in August 1998: in 1999 INSALUD communique 7/97 was applied; the Admissions and Clinical Documentation Unit and the Ambulatory Surgery Unit were set up; computerized management of surgery waiting list; surgery rooms schedule (starting at 08.30); surgery procedures per room/day (> 3); usage index (> 75%); cancellations (<3%) and surgery schedule; monthly allocation of surgery rooms depending on the type of patients on the list and monthly status report to services. The time frame studied was 5 years (1997-2001).
ResultsThe number of patients enrolled on the surgical waiting list increased by 23.98% (from 2000 to 2001), 7000 interventions were performed per year, ambulatory surgery interventions increased by 59.33% (from 1997 to 2001) and major ambulatory surgery increased by 59.75%. The surgery room usage index was 79%. No patient remained on the waiting list for more than six months (from 1998). The IMSALUD mean delay was reduced (27.7 days in 1998, 36.87 in 1999). Less than 3% of interventions were canceled (from 1998). Patients processed: 88.86% from waiting list and 78.82% regular working hours. Waiting list purges decreased (10.90% in 2001). Complexity (6.66%), mean hospital weight (27.52%) and discharge diagnosis (50%) increased while the adjusted mean length of hospital stay index (6.66%) and mean length of stay (10.97%) decreased from 1997 to 2001.
ConclusionsManagement of the surgical waiting lists was improved by merging them all into one. Surgery scheduling should take place in clinical sessions and not in consultations; the surgical block’s regulations improved efficiency, appointing a person in charge of the surgical block improved its management, and smoother running of the hospital and surgery services increased demand.
