“Today’s surgery is for a senior bladder cancer patient planned for radical cystectomy, who needs to remove the lymphoid tissue around the bladder, prostate, seminal vesicles, and iliac vessels. Thanks to the setting of ‘Surgery Day for Critical and Rare Diseases’, the preoperative waiting time for such patients has been shortened and the department is more motivated to overcome the difficulties and challenges ahead.” said Ji Zhigang, Director of the Department of Urology. In 2019, the Department of Anesthesiology and the Operating Room took the lead in setting up the “Surgery Day for Critical and Rare Diseases”, coordinating and optimizing the allocation of surgical resources, and integrating space, equipment, manpower and processes on all dimensions. After three years of exploration and development, the “Surgery Day for Critical and Rare Diseases” has expanded its reach from 4 to 12 specialties and secured breakthroughs in terms of both surgery volume and types. For example, in the first half of this year alone, up to 215 surgeries with critical and rare diseases were performed.

Surgery for patients with critical and rare diseases could be risky and difficult, requiring adequate multidisciplinary consultation, meticulous preoperative preparation, and the support of a specialized anesthesia team. When patients’ life hangs by a thread due to especially complicated conditions that need challenging surgeries, such as three-incision esophagectomy, surgery for patients with complex spinal muscular atrophy (SMA), total cystectomy and lateral skull base surgery, the medical risks are usually very high . The operation time could also be extremely long and even all-nighters are not uncommon. In such cases, the surgical team often faces unexpected situations and must fight fatigue as they go along, threatening medical safety.

“Rather than deal with things passively, we need to act proactively!” With the strong support of hospital leaders and the cooperation of relevant administrative departments, Huang Yuguang, Director of the Department of Anesthesiology, and Wang Huizhen, executive head nurse of the Operating Room, took the initiative to negotiate with the surgical team and proceed with great gusto. Thanks to these efforts, the “Surgery Day for Critical and Rare Diseases” was set up on April 17, 2019.

Where can the Surgery Day team get the human resources needed? Guided by the “baton” of hospital performance assessment, the Department of Anesthesiology and the Operating Room has settled on a set of assessment principles and indicators that see quality and safety as a prerequisite and attach equal importance to service and efficiency. With the gradual increase in human resources and related inputs, the department has adopted more granular management approaches and implemented a graded assessment of surgical risks and a localized management program, and tilted the balance of performance assessment toward what is needed by surgeries for critical and rare diseases. In August last year, the Department of Anesthesiology and the Operating Room launched the initiative of “starting early, ensuring safety, and promoting efficiency”; galvanized by it, not only 600 more surgeries have been completed per month, the subspecialty-level allocation of human resources have also been optimized for the Surgery Day .

How to ensure surgery quality and patient safety? According to the relevant system, regular surgery usually books with the Department of Anesthesiology and the Operating Room one day in advance. However, when patients with critical or rare disease decide to have surgery in outpatient clinic, the physician will immediately contact the Department of Anesthesiology and the Operating Room, which will put them on the Surgery Day express way. The surgical department will arrange for the patient to be admitted according to the surgery time, and both the Department of Anesthesiology and the Operating Room will arrange for experienced personnel to evaluate the patient thoroughly and give priority to the scheduling of the patient on the day of surgery. Starting early, the multidisciplinary team could crack the hard nut without any distraction, thereby ensuring precise perioperative management. “Over the more than three years since the beginning of the Surgery Day, we have performed significantly more surgeries that are much more difficult, but there has not been a single case of adverse event,” said Huang Yuguang proudly.

Shen Le, executive deputy director of the Department of Anesthesiology, said: “Thanks to our three years of exploration and development, we are now able to enhance the frequency of the Surgery Day from 1-2 times a week at the onset to almost regular arrangements on every workday. This not only provides convenience for the surgery team, but also offers timely treatment for patients.”

Group picture of the first batch of members of “Surgery Day for Critical and Rare Diseases” projects

Reporter: Gan Dingzhu

Correspondent: Zhang Jie, Diao Cuicui and Chen Yaqi

Picture courtesy: The Department of Anesthesiology and the Operating Room

Translator: Liu Haiyan

Editor: Chen Weiyun and Wang Yao