Cultural changes are difficult and requires great efforts from everyone involved. However, moments of crisis bring challenges and opportunities for transformation and innovation, even in processes that seems to work.
The history of surgery dates back to thousands of years ago, with historical evidence of more or less successful procedures and in varying complexities.
As a rule, surgeons performed at the patient’s home, in public squares and very rarely at universities.
According to Foucault, hospitals as we know today did not exist until a few centuries ago. Only from the expansion of navigation (and thus, the threat of epidemics in cities that were beginning to expand their urban centers) did the need for more effective sanitary controls arise, which would protect urban populations from diseases that were often imported, others arising from poor health conditions.
The first hospitals were more like charities, run by religious and lay people, where doctors could rarely be found. The other health professions as we know today simply did not exist back then.
In the transition from the 18th and 19th centuries, major developments and transformations in medical practice bring hospitals a central position in the perspective of care.
They then became the primary places for treatment, cure and training of health professionals.
Over time, several traditionally home-based activities came to be considered hospital-based ones. This is the case for deliveries and surgeries.
However, the naturalization of the hospital’s central position as a unique space for surgical (and obstetric) care brings with it a series of important contradictions, which need to be debated.
We have followed the transformation of small hospitals from years ago into large institutions, tailored for highly complex care (and cost): organ transplants, robotic surgery, care for cancer patients. In these places, expensive support structures are essential: ICUs, large central pharmacies and warehouses – where vast stocks of materials and medicines need to be maintained and managed – as well as cafeterias, laundries, administrative centers. Although only a small percentage of all patients require several of these structures, such as ICUs and robots, for example. And for all these reasons, even a small hospital tipically has about ten employees for each active bed.
The huge jump in health care costs seen in the past three decades has not necessarily meant better clinical outcomes for outpatients (or those who should be).
On the other hand, such an increase in costs implied in limiting patients’ access to health resources, in the public and private sectors. Whether due to a scarce supply of resources or limitations of coverage, the result is the lack of satisfaction of the health needs of part of the population, judicialization to obtain access or unbearable queues for procedures.
In addition to these aspects, it should be noted that hospitals are large structures focused on their own needs, rather than those of patients. Their rigid routines often do not take into account the needs and peculiarities of patients, who must fit themselves to the way the hospital and its teams work and seldomly the opposite. For example, one can prescribe a certain type of diet, as with restrictions on salt, carbohydrates, dietary fiber or fat. But hardly a patient can choose the menu for dinner or even schedule the time when the meal will be served, even within the guidelines of the medical prescription.
Similarly, let us imagine a young patient, without comorbidities and undergoing a minor procedure – who was admitted to the hospital despite the fact that he could have been sent to his home. Probably this patient would have his sleep interrupted sometimes by the nursing staff, to check vital signs. After all, they are used to visiting the infirmary at fixed times, as indicated by their institution’s routine protocols.
We know that hospitals are needed in different situations. But it is necessary to determine how much of hospital care should be offered to each patient. In other words: the patient must be at the center of the care efforts. The patient should be heard and play the most important role in decisions upon himself. It is essential for health teams to be at his disposal and not the opposite. Humanization is inherent to the Ambulatory Surgery model, which involves the patients and their caregivers (or family members), as well as the entire health team.
In summary, why choose Ambulatory Surgery?
- Because it avoids unnecessary hospitalizations, allowing the patient to return home the same day, as well as recovering with assistance from the health team;
- Because it tightens the bonds between the patient and his family environment, by involving a caregiver as a fundamental part of the process of returning home;
- Because it avoids hospital infections, acquired in general by the manipulation of health teams, involved in simultaneous care with many inpatients;
- Because it reduces the risk of acquiring airborne diseases, as in agglomerations in the inpatient sectors;
- Because it rationalizes and reduces costs in the case of outpatient procedures, allowing hospital structures to be offered to patients who really needs them;
- Because by reducing and rationalizing costs, it allows public and private health systems to increase their offer of services, democratizing access to health care;
- Because by increasing and democratizing the supply of surgical services in the public and private sectors, it reduces the costs and inconveniences of health judicializations;
- Because it enables the humanization of health care, by placing the patient and his needs at the center of the entire care process;
- Because it privileges the teamwork of health professionals, being all linked to the patient and his caregiver before, during and after the procedure;
- Because it enables safety, efficiency, quality and adequate timing of care.