I. Classification of surgery
Surgery and invasive operations are classified as various kinds of open surgery, lumpectomy and anesthesia methods, which are collectively referred to as surgery. According to their technical difficulty, complexity and risk, surgeries are classified into four levels.
Level I surgery: all kinds of surgeries with low technical difficulty, simple surgical procedures and low risk.
Level II surgery: all kinds of surgeries with average technical difficulty, uncomplicated surgical procedures and medium risk.
Tertiary surgery: various surgeries with greater technical difficulty, more complicated surgical procedures, and greater risk.
Level IV surgery: various surgeries with high technical difficulty, complicated surgical procedures and high risk.
Levels of surgeons
According to their health and technical qualifications, technical duties and years of work in the corresponding technical positions, the level of surgeons. All surgeons should be qualified to practice medicine in accordance with the law.
1.Resident doctors
1.Low seniority resident: within 3 years of the resident position, or a master’s degree, within 2 years of the resident position.
2, senior residents: more than 3 years of residency, or a master’s degree, to obtain a license to practice medicine, and has been engaged in residency for more than 2 years.
2.Officer-in-charge
1.Low senior attending physician: within 3 years in the position of attending physician, or obtained a clinical doctorate degree, and engaged in the position of attending physician for more than 2 years.
2.Senior attending physician: working as an attending physician for more than 3 years, or obtaining a clinical doctorate degree and working as an attending physician for more than 2 years.
3.Deputy chief physician.
1.Low senior associate chief physician: within 3 years of working as an associate chief physician, or with a postdoctoral degree, working as an associate chief physician for more than 2 years.
2.Senior associate chief physician: those who have been working as associate chief physician for more than 3 years.
4.Chief physician: employed in the position of chief physician workers.
Three, each level of physician surgery authority
1.Low seniority resident doctor: under the guidance of the senior doctor, can preside over the first level of surgery.
Second, senior residents: on the basis of skilled mastery of first-class surgery, under the supervision of senior doctors on the spot can gradually start second-class surgery.
Third, low-grade attending physician: can preside over the second level of surgery, under the supervision of senior doctors on the spot, and gradually launch the third level of surgery.
Fourth, senior attending physician: can preside over the third-level surgery.
5.Low senior deputy chief physician: can preside over the third level surgery, under the supervision of the senior physician on the spot, and gradually start the fourth level surgery.
6.Senior deputy chief physician: can preside over four-level surgery, under the supervision of senior doctors or according to the actual situation, can preside over new technology, new projects and scientific research projects surgery.
G. Chief physician: can preside over level four surgery as well as general new technology, new project surgery or high-risk scientific research project surgery approved by the competent department.
In addition to meeting the above requirements, the surgery presenter must be qualified for the corresponding special surgery.
Surgery approval procedure
1.The professor leading the group in the surgery department must be the chief doctor or deputy chief doctor, and the professor leading the group determines the list of operators and assistants for each surgery in the group according to the doctor’s level. If the whole department consultation is required, at least one day in advance, the chief of the department will organize the whole department consultation and approval.
2. The chief of the department approves the list of operators and assistants for each surgery in each medical group of the department, ensuring that the doctor’s level corresponds to the classification of the surgery and that the signatures take effect. As a matter of principle, we do not approve operations that are beyond the level of the surgeon. Under special circumstances, it can be approved, but must ensure that there is a superior doctor present to guide.
3. Patients should choose their doctors on the basis of the medical group and the implementation of the physician classification system as a prerequisite.
V. Surgery approval authority
Surgery approval authority refers to the approval authority for different levels of surgery to be performed, as well as different conditions and different types of surgery. Our hospital has implemented computerized management of surgery notification forms, and the written signatures of the department head and the professor in charge of the group should be included in the approval section of the pre-operative summary.
Routine surgery
Level I surgery: the professor in charge of the group will approve the surgery, and the attending physician or above will report the surgery notice.
Level II surgery: the professor in charge of the group will approve the surgery, and the senior attending physician or above will report the surgery notice.
Level 3 surgery: the chief of the department will approve the surgery, and the doctor who is the deputy chief of the department or above will report the surgery notice.
Fourth-level surgery: approval by the chief of the department, and surgery notification by senior deputy chief physician or above.
VI. Special surgery approval authority
1.Qualified prospective surgery
Qualified prospective surgery refers to surgery requiring special surgical qualification or authorization according to the regulations of the municipal or above-level health administration department. Municipal or above administrative department of health or its recognized professional academic institutions to hospitals and surgeons to issue special surgical qualification certificate or authorization certificate. Only surgeons who have obtained the corresponding type of surgical qualification have the authority to perform the surgery for which they are qualified.
2.High-risk surgery
High-risk surgery refers to any level of surgery that the chief of the surgical department determines to be of high risk. It must be discussed within the department, signed and agreed by the chief of the department and then reported to the medical department. The person in charge of the medical department will decide whether to approve the surgery himself or submit it to the vice president of business for approval.
3.Emergency surgery
Surgery can be performed when the expected level of surgery is within the level of surgical authority of the doctor on duty. If it is a high-risk surgery or if the expected surgery is beyond the level of one’s surgical authority, it should be reported urgently to the professor with the group for approval and, if necessary, to the chief of the department. However, in the case of emergency life-saving surgery, the doctor on duty has the right to and must preside over the rescue surgery as he/she deems reasonable according to the specific situation, without delaying the rescue time, if the superior doctor is temporarily unable to be present to preside over the surgery.
4.New technology, new project and scientific research surgery
1.General new technology, new project surgery, major surgery, and surgery for disability must be discussed within the department, and the department head must sign the approval on the “Important Surgery Approval Form” and report to the Medical Affairs Department for record and approval.
2. High-risk new technologies, new projects and scientific research surgeries shall be reported by the hospital to the Provincial Department of Health for approval. If necessary, the Provincial Department of Health will entrust the designated academic institutions to discuss and approve by the expert committee before implementation in the hospital.
5.Surgeries that need to be reported or approved by the medical department.
1.New or difficult major surgery of the discipline.
2.Surgeries in which famous experts from home and abroad are invited to participate.
3.Surgeries with foreseeable bad prognosis or great danger.
4.Surgeries that may cause medical disputes or re-operations with medical disputes.
5.Surgery of foreign guests, Hong Kong, Macao and Taiwan celebrities invited by the state.
6.Surgery for cadres, provincial, municipal and university leaders, famous people inside and outside the province.
7.Surgery that may lead to disfigurement or disability.
8.Large organ transplantation surgery.
The above surgeries must be discussed within the department and reported to the Medical Affairs Department for the record after the department head has signed and agreed, and the department head of the surgery department is responsible for approval.
6.Outside consultation surgery
If the practicing physicians of the hospital are invited to operate outside the hospital or abroad, they must apply for the relevant approval procedures in accordance with the requirements of the “Practicing Physicians Law” and the “Regulations on the Management of Outgoing Consultations of Physicians”. The surgery conducted by the outgoing surgeon shall not exceed the corresponding surgery level stipulated in these rules.
VII. Administrative management
1, in order to ensure medical safety, according to the responsibility of the doctor’s title, the implementation of various levels of doctors graded surgery system. Each surgical department should implement the regulations of the scope of surgery for each level of surgeon, and the leading professor or department head should approve the list of surgeons and assistants participating in surgery according to the regulations. When the surgeon upgrades the surgical level, the chief of the department and the leading professor will carry out a specific assessment and sign and seal the approval with the “pre-operative summary” to take effect.
2.Surgery is carried out in accordance with the determined division of labor of the surgical staff, and no overstepping of surgical levels is allowed. Surgery according to the condition of the need to expand the scope of surgery, or change the predetermined surgery, you need to consult a superior physician, in accordance with the provisions of the doctor graded surgery scope surgery. Such as the implementation of over the level of surgery, subject to the approval of the chief of the department and must have a senior physician on the scene to guide.
3, in addition to the ongoing surgery surgeon to ask for instructions to a higher doctor, the higher doctor shall not participate in surgery directly without consultation with the patient, without participating in pre-operative discussions, without surgical procedures.
4, new technology, new projects, research surgery must obtain the informed consent of patients or immediate family members, and sign the informed consent notification.
The department and the person responsible for violating this regulation over the authority of surgery, once confirmed, will be held responsible for the department and the person responsible; for the resulting medical accidents, the corresponding personnel will be held responsible.
To clarify the surgical authority of doctors at all levels is a powerful measure to standardize medical behavior, protect medical safety and safeguard the interests of patients, and surgical departments and doctors at all levels must strictly follow the implementation.
Surgical grading standards
Bone and Joint Surgery
Grade 1 surgery
1.general debridement, muscle and tendon repair 2.fracture of limbs with manipulation and external fixation in plaster 3.bone retraction 4.replacement of shoulder and elbow joint 5.tendon sheath cystectomy 6.joint cavity incision and drainage 7.fascial interval syndrome incision and decompression
Secondary surgery
1.Single extremity long tubular fracture with incision and internal fixation 2.Open fracture management single extremity, single site, 3.Complex debridement, tendon repair 4.Tendon transposition, tendon lengthening 5.Upper extremity joint dislocation with incision and joint capsule repair 6.Acute and chronic osteomyelitis lesion removal 7.Joint dislocation with internal fixation 8.Multiple open fracture management 9.Multiple extremity long tubular fracture 10.Section and internal fixation of multiple long tubular fractures of the limbs 10.Section and internal fixation of long tubular fractures of the limbs requiring special technical requirements 11.Escalation of six major joints 12.Arthroscopic meniscectomy and synovectomy 13.Bone grafting, joint grafting, free bone and muscle grafting with blood vessels
Tertiary surgery
1.Bunion and valgus orthopedic surgery 2.Femoral neck fracture fixation 3.Orthopedic surgery and bone lengthening 4.Joint fusion 5.Arthroscopic structural reconstruction 6.Arthroplasty, hemiarthroplasty, total hip replacement 7.Quadruple amputation 8.SPR surgery for cerebral palsy 9.Proximal joint comminuted fracture treatment affecting joint function
Grade IV surgery
1.Pelvic fracture incision and internal fixation 2.Sacral tumor resection 3.Artificial total joint replacement, revision surgery, artificial main hip replacement for special types of diseases 4.Artificial total knee replacement 5.Section of bone tumor and its reconstruction 6.Congenital hip dislocation surgery 7.New technology and new project surgery
Spine surgery
Primary surgery
1.Cranial retraction 2.Sternocleidomastoid dissection 3.Extra-vertebral plate foreign body removal 4.Soft tissue debridement and exploration 5.Soft tissue abscess incision and drainage
Secondary surgery
1.Endograft removal 2.Posterior laminectomy, articular eminence and intertransverse fusion 3.Extra-vertebral canal benign tumor removal 4.Posterior cervical and lumbar laminectomy spinal canal decompression 5.Cervical, thoracic and lumbar tuberculosis simple lesion removal
Tertiary surgery
1.Conventional removal of lumbar disc nucleus pulposus by posterior approach2.Lumbar disc nucleus pulposus removal by posterior small incision3.Thoracic and lumbar fractures by posterior resection and restoration by indirect decompression and internal fixation by bone grafting and fusion4.Cervical laminoplasty by posterior approach5.Cervical disc removal by anterior approach or subtotal resection by bone grafting and fusion by internal fixation6.Thoracic spinal canal decompression by posterior approach7.Thoracic spinal arch screwing by internal fixation8.Thoracic and lumbar disc nucleus pulposus by posterior approach Removal of intervertebral implants and fusion9.Posterior incision and reinstatement of lumbar slipped vertebral implants and fusion10.Anterior decompression and fusion of thoracic and lumbar vertebrae11.Posterior incision and reinstatement of thoracic and lumbar spine injury360b decompression and fusion12.Incision and reinstatement of upper cervical spine injury13.Intravertebral canal tumor resection
Level IV surgery
1.Cervical spine internal fixation by arch root screw 2.Lower cervical and thoracolumbar spine injury posterior resection and restoration by direct decompression implant fusion 3.Spinal tuberculosis and benign tumor anterior or posterior resection of lesions by implant fusion internal fixation 4.Spinal malignancy anterior and posterior resection of diseased vertebrae by structural reconstruction 5.Sacral subtotal resection 6.Sacral total resection 7.Single correction of scoliosis by implant fusion internal fixation 8. Spinal deformity osteotomy and orthopedic implant fusion internal fixation9, spinal deformity revision10, percutaneous disc decompression11, percutaneous vertebral body or retrognathism12, percutaneous spinal internal fixation13, endoscopic disc removal or release14, endoscopic spinal internal fixation15, artificial disc replacement