Plan of a day surgeon unit
Keywords:
OUTPATIENT SURGICAL PROCEDURES, HEALTH SERVICES ADMINISTRATION
Abstract
A plan to set in a day surgeon unit (UCD) of the Centro de Asistencia del Sindicato Médico del Uruguay (CASMU), located in the Sanatorio 1, a 107 bed-hospital, which is part of a network of CASMU hospitals (462 beds). So far, there have no been surgical units organized like this proposal.
The aim of the UCD is to apply an ambulatory way of surgical assistance in order to reach high quality in the service and to reduce costs by means of decreasing stay-in hospital. The objective is to modify the organization of the current surgical block and to install a new area of day assistance for selected operations.
The general plan includes hospital indicators, surgical indicators, use of beds and projections of this new type of surgical assistance. The operational plan is analized in its different compounds: general strategy, organization, activity timetable, assessment. The plan implies a variation in the management of surgical hospitalarian services and shows satisfactory results on institutional surgical activity in terms of cost-effectiveness, quality and satisfaction of patients. This national experience visualizes the oncoming development of the model according to pathologies and techniques to be considered.
a. The evaluation and cost-effectiveness analysis of the CASMU UCD is studied in another work by the same authors(1).
References
1) Chirigliano GV, Noceti MC. Evaluación de una unidad de cirugía del día. Rev Panam Salud Publica 2002; 12(5): 333-8.
2) Pollock AM, Dunningan M, Gaffney D, Macfarlane A, Majeed F. What happens when the private sector plans hospital services for the NHS: three case studies under the private finance iniciative. NHS Consultants' Association, Radical Statics Health Group, and the NHS Support Federation. BMJ 1997; 314(7089): 1266-71.
3) Edwards N, Harrison A. Planning hospitals with limited evidence: a research and policy problem. BMJ 1999; 319(7221): 1361-3.
4) Busse R, Schwartz FW. Financing reforms in the German hospital sector: from full cost cover principle to prospective case fees. Med Care 1997; 35(10 Suppl): S40-9.
5) Botella JA, Martínez A, Uribe N, Valero J, Pardo J, Ruiz J. Ambulatory surgery: is a multidisciplinary unit necessary? Br J Surg 1997; 84(2 Suppl): 124.
6) Bartlett MK, Battit GE, Rockett AM, Perry EJ, Austen MG. The role of surgery on ambulatory patients in one teaching hospital. Arch Surg 1979; 114(3): 319-20.
7) Weisbrod BA. The health care quadrilemma: an essay on technological change, insurance, quality of care an cost containment. J Econ Lit 1991; 29: 523-52.
8) Board N, Caplan G. Implications of decreasing surgical lengths of stay. Austr Health Rev 2000; 23(2): 62-76. http://www.ncbi.nlm.nih.gov. [Consulta: 8 setiembre 2002].
9) Cueto GJ. Manual de Cirugía Ambulatoria. México: Secretaría de Salud, 1993.
10) Dexter F, Tinker JH. Comparisons between desflurane and isoflurane or propofol on time to following commands and time to discharge: a metaanalysis. Anesthesiology 1995; 83(1): 77-82.
11) Miller JM. Organization of day surgery. Oxford: Day Surgery Unit The Churchill Hospital, 1991.
12) Golub R, Cantu R, Sorrento JJ, Stein HD. Efficacy of preadmission testing in ambulatory surgical patients. Am J Surg 1992; 163(6): 565-70.
13) Smith AF, Pittaway AJ. Premedication for anxiety in adult day surgery. (Cochrane Review). The Cochrane Library 1999, Issue3.
14) American Society of Anesthesiologists. La anestesia y usted. Anestesia para cirugía ambulatoria. Illinois: ASAhq, 1997. http://www.ASAhq.org [Consulta: 11 setiembre 2002].
15) Jacksn JL. The german system: Lessons for Reform in the United States. Arch Inten Med 1997; 157(2): 155-60.
16) McCallion J, Krenis LJ. Preoperative Cardiac Evaluation. Am Fam Physician 1992; 45(4): 1723-32.
17) Forrest, JB, Rehder K, Cahalan MK, Goldsmith CH. Multicenter Study of General Anesthesia III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992; 76(1): 3-15.
18) Cullen DJ, Apolone G, Greenfield S, Guadagnoli E, Cleary P. ASA Physical Status and age predict morbidity after three surgical proceedures. Ann Surg 1994; 220(1): 3-9.
19) Duncan PG, Cohen MM, Tweed WA, Biehl D, Pope WD, Merchant RN, et al. The Canadian four-centre study of anaesthetic outcomes: III. Are anaesthetic complications predictable in day surgical practice? Can J Anaesth 1992; 39(5 Pt 1): 440-8.
20) American Academy of Pediatrics. Evaluation and preparation of pediatric patients undergoing anesthesia. Pediatrics 1996; 98(3): 502-8. http://www.aap.org/policy/01566.html . [Consulta: 10 setiembre 2002].
21) Brennan PF. Patient satisfaction and normative decision theory. J Am Med Inform Assoc 1995; 2(4): 250-9.
22) Schneck LH. Ambulatory surgery Its origins, its present state, and its future direction. AORN J 1984; 40(2): 248-50.
23) Palmer JS, Worwag EM, Conrad WG, Blitz BE Chodak G W. Same day surgery for radical retropubic prostatectomy: is it an attainable goal? Urology 1996; 47(1): 23-8.
24) McCormack K, Scott NW, Go PMNYH, Ross S, Grant AM, on behalf of the EU Hernia Trialists, Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. (Cochrane Review) The Cochrane Library 2002, Issue 3.
25) Lawrence K, Mc Whinnie D, Goodwin A, Doll H, Gordon J, Gray, A, et al. Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results. BMJ 1995; 311(7011): 981-5.
26) Stewart MG, Hillman EJ, Donovan DT, Tanli SH.The effects of a practice guideline on endoscopic sinus surgery at an academic center. Am J Rhinol 1997; 11(2): 161-5.
27) Society for Surgery of the Alimentary Tract. Patient Care Committee. Treatment of gallstone and gallbladder disease. J Gastrointest Surg 1998; 2(5): 485-6 http://www.ssat.com. [Consulta: 26 agosto 2002].
28) Society of American Gastrointestinal Endoscopic Surgeons. Guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2000; 14(8):771-2. http://www.sages.org/sg_pub6.html. [Consulta: 10 setiembre 2002].
29) Society for Surgery of the Alimentary tract. Surgical repair of groin hernias. http://www.ssat.com/guidelines/hernia6.htm. [Consulta: 10 setiembre 2002].
30) American Society of Plastic Surgeons. Gynecomastia. http://www.guideline.gov. [Consulta: 11 setiembre 2002].
31) American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of hemorrhoids. http://www.guidelines.gov. [Consulta: 11 noviembre 2002].
32) Young D. Acute pain management..University of Iowa Ger. Nursing Interventions Center. http://www.guidelines.gov. [Consulta: 12 noviembre 2002].
33) 33 American Society of Colon and Rectal Surgeons. Practice parameters for ambulatory anorectal surgery. 1991 (reaffirmed 1998-1999). http://www.guidelines.gov [Consulta: 5 noviembre 2002].
34) Davis JE. Major ambulatory surgery of the general surgical patient. Management of breast disease and hernia of the abdominal wall. Surg Clin North Am 1987; 67(4): 733-60
35) Bard C. Perioperative Management. San Diego Health Care System. Core subjects. http://www.fascrs.org [Consulta: 2 marzo 2003].
36) Klimberg IW, Locke DR, Dersch MW, Taub HC. TURP as same-day surgery. Contemporary Urology; nov1996. http://www.contemporaryurology.com/be_core/u/sections/c_past_issues/index.jsp?navtype=u&showPoll= no&filename=. [Consulta: 26 agosto 2002].
37) Lawrence K, Mc Whinnie, Goodwin A, Gray A, Gordon J, Storie J et al. An economic evaluation of laparoscopic versus open inguinal hernia repair. J Public Health Med 1996; 18(1):41-8.
38) Farinas LP, Griffen FD. Cost containment and totally extraperitoneal laparoscopic herniorrhaphy. Surg Endosc 2000; 14(1): 37-40.
39) Rose K, Waterman H, Toon L, McLeod D, Tullo A. Management of day-surgery patients with cataract attending a peripheral ophthalmic clinic. Eye 1999; 13(Pt 1): 71-5.
40) Cresswell PA, Allen ED, Tomkinson J, Chapman FM, Pickering S, Donaldson LJ. Cost effectiveness of a single-function treatment center for cataract surgery. J Cataract Refract Surg 1996; 22(7): 940-6.
41) Towle A. Changes in health care and continuing medical education for the 21st century. BMJ 1998; 316(7127):301-4.
42) Haycock J, Stanley A, Edwards N, Nicholls R. Changing hospitals. BMJ 1999; 319(7219): 1262-4.
2) Pollock AM, Dunningan M, Gaffney D, Macfarlane A, Majeed F. What happens when the private sector plans hospital services for the NHS: three case studies under the private finance iniciative. NHS Consultants' Association, Radical Statics Health Group, and the NHS Support Federation. BMJ 1997; 314(7089): 1266-71.
3) Edwards N, Harrison A. Planning hospitals with limited evidence: a research and policy problem. BMJ 1999; 319(7221): 1361-3.
4) Busse R, Schwartz FW. Financing reforms in the German hospital sector: from full cost cover principle to prospective case fees. Med Care 1997; 35(10 Suppl): S40-9.
5) Botella JA, Martínez A, Uribe N, Valero J, Pardo J, Ruiz J. Ambulatory surgery: is a multidisciplinary unit necessary? Br J Surg 1997; 84(2 Suppl): 124.
6) Bartlett MK, Battit GE, Rockett AM, Perry EJ, Austen MG. The role of surgery on ambulatory patients in one teaching hospital. Arch Surg 1979; 114(3): 319-20.
7) Weisbrod BA. The health care quadrilemma: an essay on technological change, insurance, quality of care an cost containment. J Econ Lit 1991; 29: 523-52.
8) Board N, Caplan G. Implications of decreasing surgical lengths of stay. Austr Health Rev 2000; 23(2): 62-76. http://www.ncbi.nlm.nih.gov. [Consulta: 8 setiembre 2002].
9) Cueto GJ. Manual de Cirugía Ambulatoria. México: Secretaría de Salud, 1993.
10) Dexter F, Tinker JH. Comparisons between desflurane and isoflurane or propofol on time to following commands and time to discharge: a metaanalysis. Anesthesiology 1995; 83(1): 77-82.
11) Miller JM. Organization of day surgery. Oxford: Day Surgery Unit The Churchill Hospital, 1991.
12) Golub R, Cantu R, Sorrento JJ, Stein HD. Efficacy of preadmission testing in ambulatory surgical patients. Am J Surg 1992; 163(6): 565-70.
13) Smith AF, Pittaway AJ. Premedication for anxiety in adult day surgery. (Cochrane Review). The Cochrane Library 1999, Issue3.
14) American Society of Anesthesiologists. La anestesia y usted. Anestesia para cirugía ambulatoria. Illinois: ASAhq, 1997. http://www.ASAhq.org [Consulta: 11 setiembre 2002].
15) Jacksn JL. The german system: Lessons for Reform in the United States. Arch Inten Med 1997; 157(2): 155-60.
16) McCallion J, Krenis LJ. Preoperative Cardiac Evaluation. Am Fam Physician 1992; 45(4): 1723-32.
17) Forrest, JB, Rehder K, Cahalan MK, Goldsmith CH. Multicenter Study of General Anesthesia III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992; 76(1): 3-15.
18) Cullen DJ, Apolone G, Greenfield S, Guadagnoli E, Cleary P. ASA Physical Status and age predict morbidity after three surgical proceedures. Ann Surg 1994; 220(1): 3-9.
19) Duncan PG, Cohen MM, Tweed WA, Biehl D, Pope WD, Merchant RN, et al. The Canadian four-centre study of anaesthetic outcomes: III. Are anaesthetic complications predictable in day surgical practice? Can J Anaesth 1992; 39(5 Pt 1): 440-8.
20) American Academy of Pediatrics. Evaluation and preparation of pediatric patients undergoing anesthesia. Pediatrics 1996; 98(3): 502-8. http://www.aap.org/policy/01566.html . [Consulta: 10 setiembre 2002].
21) Brennan PF. Patient satisfaction and normative decision theory. J Am Med Inform Assoc 1995; 2(4): 250-9.
22) Schneck LH. Ambulatory surgery Its origins, its present state, and its future direction. AORN J 1984; 40(2): 248-50.
23) Palmer JS, Worwag EM, Conrad WG, Blitz BE Chodak G W. Same day surgery for radical retropubic prostatectomy: is it an attainable goal? Urology 1996; 47(1): 23-8.
24) McCormack K, Scott NW, Go PMNYH, Ross S, Grant AM, on behalf of the EU Hernia Trialists, Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. (Cochrane Review) The Cochrane Library 2002, Issue 3.
25) Lawrence K, Mc Whinnie D, Goodwin A, Doll H, Gordon J, Gray, A, et al. Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results. BMJ 1995; 311(7011): 981-5.
26) Stewart MG, Hillman EJ, Donovan DT, Tanli SH.The effects of a practice guideline on endoscopic sinus surgery at an academic center. Am J Rhinol 1997; 11(2): 161-5.
27) Society for Surgery of the Alimentary Tract. Patient Care Committee. Treatment of gallstone and gallbladder disease. J Gastrointest Surg 1998; 2(5): 485-6 http://www.ssat.com. [Consulta: 26 agosto 2002].
28) Society of American Gastrointestinal Endoscopic Surgeons. Guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2000; 14(8):771-2. http://www.sages.org/sg_pub6.html. [Consulta: 10 setiembre 2002].
29) Society for Surgery of the Alimentary tract. Surgical repair of groin hernias. http://www.ssat.com/guidelines/hernia6.htm. [Consulta: 10 setiembre 2002].
30) American Society of Plastic Surgeons. Gynecomastia. http://www.guideline.gov. [Consulta: 11 setiembre 2002].
31) American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of hemorrhoids. http://www.guidelines.gov. [Consulta: 11 noviembre 2002].
32) Young D. Acute pain management..University of Iowa Ger. Nursing Interventions Center. http://www.guidelines.gov. [Consulta: 12 noviembre 2002].
33) 33 American Society of Colon and Rectal Surgeons. Practice parameters for ambulatory anorectal surgery. 1991 (reaffirmed 1998-1999). http://www.guidelines.gov [Consulta: 5 noviembre 2002].
34) Davis JE. Major ambulatory surgery of the general surgical patient. Management of breast disease and hernia of the abdominal wall. Surg Clin North Am 1987; 67(4): 733-60
35) Bard C. Perioperative Management. San Diego Health Care System. Core subjects. http://www.fascrs.org [Consulta: 2 marzo 2003].
36) Klimberg IW, Locke DR, Dersch MW, Taub HC. TURP as same-day surgery. Contemporary Urology; nov1996. http://www.contemporaryurology.com/be_core/u/sections/c_past_issues/index.jsp?navtype=u&showPoll= no&filename=. [Consulta: 26 agosto 2002].
37) Lawrence K, Mc Whinnie, Goodwin A, Gray A, Gordon J, Storie J et al. An economic evaluation of laparoscopic versus open inguinal hernia repair. J Public Health Med 1996; 18(1):41-8.
38) Farinas LP, Griffen FD. Cost containment and totally extraperitoneal laparoscopic herniorrhaphy. Surg Endosc 2000; 14(1): 37-40.
39) Rose K, Waterman H, Toon L, McLeod D, Tullo A. Management of day-surgery patients with cataract attending a peripheral ophthalmic clinic. Eye 1999; 13(Pt 1): 71-5.
40) Cresswell PA, Allen ED, Tomkinson J, Chapman FM, Pickering S, Donaldson LJ. Cost effectiveness of a single-function treatment center for cataract surgery. J Cataract Refract Surg 1996; 22(7): 940-6.
41) Towle A. Changes in health care and continuing medical education for the 21st century. BMJ 1998; 316(7127):301-4.
42) Haycock J, Stanley A, Edwards N, Nicholls R. Changing hospitals. BMJ 1999; 319(7219): 1262-4.
Published
2004-03-31
How to Cite
1.
Chirigliano GV, Noceti MC. Plan of a day surgeon unit. Rev. Méd. Urug. [Internet]. 2004Mar.31 [cited 2024Nov.17];20(1):19-1. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/928
Section
Original Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
