1 dr hg-doctor-ambulatory-surgery-requirements_ncas_2011
AMBULATORY SURGERY Requirements – Benefits DR. H. G. DOCTOR M.S., F.R.C.S., F.I.C.S., F.A.C.R.S.I., F.I.A.G.E.S. Vice President, Medical Services NOVA Medical Centres, Mumbai Member of Ambulatory Surgery Centers, USA. President, Hernia Society Of India. Prof. Emeritus of SurgeryGrant Medical College & Sir J.J. Group of Hospitals, Mumbai.
HISTORICAL BACKGROUND• The concept of Ambulatory Surgery was started in 1909 by James Nicholl. He was a surgeon at western infirmary, Glasgow, Scotland.• In 1912, Ralph Waters, Anaesthetist, Iowa, USA, opened “ Down-town anaesthesia clinic”.• In 1969, Walter Redd, surgeon, started “Phoenix Surgicenter” where hernia cases were also operated with same day discharge.• Benefits of ambulatory surgery were more and better realized after World War II.• Eric Farquharson described in 1955 consecutive 458 inguinal hernia repairs performed as day care cases.
INTRODUCTION• Studies worldwide have shown that day care surgery delivers the same high quality care and is as safe as given to hospital patients.
• It is a planned procedure on selected group of patients who are admitted and discharged on the same day of their surgery but who require appropriate facilities, care and time for recovery.• Due to newer modalities of laser, ultracission and endoscopes being available, minimal access surgery, and all endoscopic procedures also can be performed.
REQUIREMENTS• State – of – the art operation theatres are mandatory along with comfortable and hygienic environment.• Selection of an ideal patient and ideal standard surgical procedure.• Preadmission surgical, medical and anaesthetic assessment. Ambulatory surgery centre should have ideal diagnostic and surgical equipment and a sophisticated laboratory.• Should be supervised by committed & dedicated surgeons, physicians, anaesthetists & nurses to ensure highest standards of patient care.
REQUIREMENTS ( CONTD…)• Clear Pre and post – operative instructions.• Post – operative medications should be in oral form.
REQUIREMENTS ( CONTD…)• Patients with stable vital signs for at least 1 hour; orientation to time, place, and persons only should be sent home.• Availability of a responsible person to transport the patient home and stay with him overnight.• Proper guidelines should be provided, implemented and audited regularly.• Facilities should be available for overnight stay if necessary and should have a liason with nearest major hospital in unforeseen complications of surgery and anaesthesia.
BENEFITS• Ambulatory surgery provides high quality, patient – centered treatment that is safe, efficient and effective and is accompanied by a lower incidence of hospital acquired infection.
BENEFITS (CONTD….)• Early return to work reduces the manhour loss, as compared with in patient treatment.• Patients are more comfortable and relaxed in their own environment.• Waiting lists of indoor patients are reduced.• Cost reduction and better utilization of resources and it is economical.• Reduced incidence of DVT as prolonged bed rest is not needed.
BENEFITS (CONTD….)• Additionally, ambulatory surgery enables busy professionals to return home and recover faster, enhancing their productivity by eliminating avoidable hospitalization.• Insurance companies also support the use of ambulatory care facilities, primarily because of decreased cost.
CONCLUSION• Ambulatory Surgery is now a global trend.• Over 70% of elective surgeries in the USA and 65% in UK are performed this way.• Ambulatory Surgery is getting well established in India also.