How to?

Ambulatory Surgery programs are always multidisciplinary and patient-centered. Patients are the focus of all care by specialized teams. But after all: how to implement an outpatient surgery program?

The concept of Ambulatory Surgery presupposes the existence of a specific pathway that the patient follows from the beginning of his journey.

Thus, from the moment a patient is referred or even spontaneously seeks outpatient surgery, he must be welcomed by a multidisciplinary team that, in addition to the professional responsible for carrying out the procedure (surgeon, dentist, endoscopist, gynecologist … ), should be minimally constituted by nursing and anesthesiologist professionals, preferably those who will be responsible for the procedure.

This prior contact is essential so that there is personal knowledge of all links in the chain of attention. This contact can be in person or even remote, as long as in accordance with the guidelines and legislations for health communications in the location where the program is established. In this way, it is necessary to guarantee not only a fluid communication but above all, the initial connection of all parties.

Therefore, when the patient is admitted to the Outpatient Surgery Unit, he will be literally welcomed. Instead of a foreign body, the patient is expected for the procedure, in a way that all professionals involved in the care chain already know it, as well as the essential details of its clinical context: the reason why the procedure will be held, general aspects that can influence the clinical outcome and the social context in which the patient is.

In other words: it is important to know the patient’s peculiarities and surroundings. Is it someone who lives less than an hour from the facility where he will be served? Does he or she has an individual means of transportation that can guarantee his or her safe return home after discharge? Does he or her has a capable adult who can aid assisting for at least the first 24 hours after the procedure (in selected cases, this recommendation may not be essential)? Are the patient able to maintain communication with the team responsible for the care and to return to a referenced unit in case of complications?

Thus, if there is a previous link between patient, caregiver and team, the same safe surgery protocols routinely used in large hospitals can be optimized in an outpatient surgery pathway. After all, prior knowledge among all those involved in care minimizes mistakes and failures.

The procedure itself usually develops in a very similar way to what would happen in a hospital, but always keeping in mind the intraoperative care recommended for an agile and safe recovery, as recommended in the ERAS strategy protocols. Thus, the choice should always rely on minimally invasive procedures, when possible.

The way to anesthetize the patient is undoubtedly a great difference in the doctor-patient contact in Ambulatory Surgery. After all, everything is done in order to minimize the main complications that occur frequently in anesthesia performed in a hospital environment and that often prevent or hinder the patient’s early hospital discharge. As examples we can mention pain, nausea and vomiting that cannot be controlled with oral medications, as well as urinary retention.

Thus, in Ambulatory Surgery, spinal blocks, orotracheal intubation and use of opioids, for example, are avoided. Everything is done thinking about the patient’s prompt recovery and home delivery 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 the day after, one week and thirty days after discharge. At the end of the process, satisfaction surveys – in which namelessness is guaranteed – are essential for team feedback and constant improvement of protocols and processes.

Therefore, we can synthesize the Ambulatory Surgery strategy as a concept that involves multidisciplinary care centered on the patients and their needs, well-defined pathways and protocols, as well as constant evaluation of results.

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