Why?
Cultural changes are difficult and involve great effort on the part of everyone involved. However, moments of crisis bring challenges and opportunities for transformation and innovation, even in processes that seem to work.
The history of surgery records its beginnings thousands of years ago, with countless historical evidences of more or less successful procedures and of varying complexities.
As a rule, the work of surgeons took place at the patient’s home, in public squares and very rarely in universities.
According to Foucault, hospitals as we know them today did not exist until a few centuries ago. Only with the expansion of navigation (and thus, the threat of epidemics in cities that began 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 conditions of very precarious life.
The first hospitals were more like charitable works, run by religious and lay people, where doctors could rarely be found. The other health professions as we know them today simply did not exist.
In the transition between the 18th and 19th centuries, major developments and transformations in medical practice brought hospitals to a central position in the perspective of care.
They then became the primary places for treatment, healing and training of health professionals.
Over time, several traditionally domestic activities began to be considered hospital activities. This is the case with deliveries and surgeries.
However, the naturalization of the central position of the hospital as the only space for surgical (and obstetric) care brings with it a series of important contradictions that need to be discussed. We follow the transformation of the small hospitals of years ago into large complexes, tailored for high complexity (and costly) care: organ transplants, robotic surgery, cancer patient care. In these spaces, expensive support structures are indispensable: ICUs, large central pharmacies and warehouses – where vast stocks of materials and medicines need to be maintained and managed – canteens, laundries, administrative centers. Even though only a small percentage of all patients need several of these structures, such as ICUs and robots, for example. And for all this, even a small hospital usually has about ten employees for each active bed.
The huge leap in health care costs observed over the past three decades has not necessarily meant better clinical outcomes for outpatients (or that they should be).
On the other hand, such an increase in costs implies a limitation of patients’ access to health resources, in the public and private spheres. Either because of the scarce supply of resources or because of coverage limitations. The result is the non-satisfaction of the health needs of part of the population, judicialization to obtain access or queues for procedures.
In addition to these aspects, it should be noted that hospitals are large structures focused on their own needs, more than those of patients. Their rigid routines often do not take into account the needs and peculiarities of patients, who must adapt to the hospital’s way of working and its teams, rarely the other way around. One can, for example, prescribe a certain type of diet, such as restrictions on salt, carbohydrates, food residues or fat. But it is difficult for a patient to choose the menu for dinner or even the time at which the meal will be served, even within the guidelines of the medical prescription.
Similarly, let’s imagine a young patient, without comorbidities and undergoing a minor procedure – who has been hospitalized despite the fact that he could have been sent home. This patient would probably have his sleep interrupted a few times by the nursing staff to check vital signs. After all, they are used to visiting the ward at fixed times, as indicated by their routine.
We know that hospitals are needed in many situations. But it is necessary to determine how much hospital care should be offered to each patient. In other words: the patient must be at the center of the care chain. It is necessary that he be heard, that he can give his opinion and decide. It is essential that health teams are at your disposal and not the other way around. Humanization is inherent to the Ambulatory Surgery model, a model that involves the patient and their caregiver (or family members) and the entire health team.
In short, why opt for outpatient surgery?
- Because it avoids unnecessary hospitalizations, allowing the patient to return to their home on the same day, as well as recovering with the assistance of the health team;
- Because it strengthens 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 nosocomial infections, generally acquired by the handling of health teams, involved in the simultaneous care of many hospitalized patients;
- Because it reduces the risk of acquiring communicable diseases, such as in crowds in hospitalization sectors;
- Because it rationalizes and reduces costs in the case of outpatient procedures, allowing hospital structures to be offered to patients who need them;
- Because by reducing and rationalizing costs, it allows public and private health systems to increase their service offering, democratizing access to health care;
- Because by increasing and democratizing the supply of surgical services in the public and private spheres, it reduces the costs and wear and tear of judicialization in health;
- Because it enables the humanization of health care, by placing the patient and their needs at the center of the entire care chain;
- Because it favors the teamwork of health professionals, all of whom are linked to the patient and their caregiver before, during and after the procedure;
- Because it enables safety, efficiency, quality and speed of care.
