How to?
Ambulatory Surgery programs are always multidisciplinary and patient-centered. He is the focus of all care on the part of specialized teams. But after all: how to implement an outpatient surgery program?
The concept of Ambulatory Surgery presupposes the existence of its own circuit – that is, a trajectory – that the patient follows from the beginning of his journey.
Thus, from the moment a patient is referred or even spontaneously seeks care in outpatient surgery, he or she must be welcomed by a multidisciplinary team that, in addition to the professional responsible for performing the procedure (surgeon, dentist, endoscopist, gynecologist… ), should be minimally made up of nursing professionals and anesthesiologists, preferably the same ones who will be responsible for the procedure. This previous contact is essential so that there is a previous and personal knowledge of all the links in the chain of attention.
This contact can be face-to-face or even remote, as long as it is in accordance with the guidelines for telecare in health, in force in the location where the program is established. In this way, not only fluid communication must be ensured, but above all the initial linkage of all parties.
Therefore, when the patient is admitted to the Ambulatory Surgery Unit (UCA) he will be literally welcomed. Instead of a foreign body, it is expected for your procedure, so that all professionals involved in the care chain already know it, as well as the essential details of its clinical context: the reason or reason for the procedure, general aspects that may influence the clinical outcome and the social context in which the patient is.
In other words: it is important to know the peculiarities of the patient and his environment. Is it someone who lives less than an hour from the UCA where he will be treated? Do you have an individual means of transport that can guarantee your safe travel home after your discharge? Do you have a capable adult who can help you for at least the first 24 hours after the procedure (in selected cases, this recommendation may not be essential)? Are you able to maintain communication with the team responsible for your care and return to a referenced Unit in case of intercurrences?
In this way, with a previous link between patient, caregiver and team, the same protocols routinely used in large Safe Surgery hospitals can be optimized in an outpatient surgery circuit. After all, prior knowledge among all those involved in care minimizes misunderstandings and failures.
The procedure itself is usually carried out in a very similar way to what would happen in a hospital, but always keeping in mind the transoperative care recommended for a quick and safe recovery, as recommended in the ERAS strategy protocols. Thus, the choice should always fall on minimally invasive procedures, when applicable.
The way to anesthetize the patient is undoubtedly a great differential in the doctor-patient contact in outpatient surgery. After all, everything is done in such a way as to minimize the main intercurrences that frequently occur in an anesthesia performed in a hospital environment and that, many times, prevent or hinder the patient’s early hospital discharge. Examples include pain, nausea and vomiting that cannot be controlled with oral medications and urinary retention.
Thus, in Ambulatory Surgery, spinal blocks, orotracheal intubation and the use of opioids, for example, are avoided. Everything is done thinking about the prompt recovery of the patient and home release in a few hours.
Likewise, the interaction between surgeon, anesthetist and nursing staff during the procedure is essential to ensure an optimized clinical outcome.
Last but not least, immediate and late postoperative care, generally led by nursing teams. Standardized questionnaires are applied 24 hours after discharge, one week and thirty days later. At the end of the process, satisfaction surveys – anonymity being guaranteed – are essential for team feedback and constant improvement of protocols and processes.
Therefore, we can summarize the Ambulatory Surgery strategy as a concept that involves multidisciplinary care centered on the patient and his needs, a circuit and well-defined action protocols and constant evaluation of results.
