Ambulatory surgery outcomes: a survey of office-based delivery

Surgical site infection after hand surgery outside the operating theatre: a systematic review

We carried out a systematic review to determine the incidence of infection for hand surgery done in settings other than the operating theatre. Databases were searched and a PRISMA chart created by three independent reviewers. From 1200 studies identified, 46 full text articles were reviewed and six were included (two Level 3 studies and four Level 4). In three studies there were no infections after surgery in an office, procedure room or emergency department. Two studies with a combined number of 1962 procedures reviewed carpal tunnel decompressions and reported identical infection rates of 0.4%. Although the current evidence is of poor quality, it suggests that some types of hand surgery may be done outside the operating theatre without increasing the risk of infection.

LEVEL OF EVIDENCE

IV.

Patient safety in outpatient surgery: the viewpoint of the healthcare providers

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.

The pitfalls of regulating office-based surgery by state legislatures and boards of medical examiners

Many surgical specialties currently provide their patients with cost-effective surgical procedures that are performed safely in an office-based setting. However, the growing number of procedures performed in this setting has lead many state legislatures and boards of medical examiners to the belief that these procedures must somehow be regulated to ensure patient safety. The first pitfall is demonstrating that a problem with safety exists, in spite of the fact that numerous published, peer-reviewed articles have proven that there is no problem. While it is relatively easy to develop a set of criteria to meet in order to certify a facility in which office surgery is to be performed, it is exceedingly difficult to determine similar criteria or scope of practice definitions that can be used fairly and accurately to determine which physicians are qualified to use those facilities. The use of hospital privileges, board certification, transfer agreements or extramural certification of facilities all have been recommended at one time or another as methods to determine physician qualifications, but no single standard has been developed that accurately reflects a fair and impartial method of determine physician qualifications.

[Adjusting a surgery department to new conditions in the German health service: day surgery, short-stay surgery, vascular centers and wound centers]

In April 1994, after the preconditions for ambulatory surgery came into effect, the day surgery ward was opened in the Hamburg-Harburg General Hospital. Besides ambulatory operations, this ward provides all surgical pre- and postoperative care. In addition to the surgical sections, different departments (urology, gynecology, dentistry, radiology, ophthalmology) take advantage of the ward. As preoperative diagnostics also could be completed ambulatorily, we were then able to establish a short-stay surgery department. This ward was opened in June 1996. One year later, the vascular center ("Gefässcentrum Harburg") was established by the departments for surgery, radiology, and angiology. This structure has been integrated into the day and short-stay surgery wards functionally and spatially. With the organizational structures mentioned and by setting up a wound consultation service, it is possible to optimize the capacity for admissions, operations, and beds. Government and health insurance demands for better processing can be filled and efficiency is increased.