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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1118-1123, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31874526

RESUMEN

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Atención al Paciente/normas , Guías de Práctica Clínica como Asunto/normas , Proctectomía/normas , Anciano , Canal Anal/cirugía , Humanos , Recto/cirugía
2.
Rev Col Bras Cir ; 46(3): e20192197, 2019 Jul 10.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31291434

RESUMEN

This article proposes the use of a safe surgical checklist in the teaching of the discipline of Ambulatory Surgery during medical graduation. It discusses its benefits and potential implementation and adherence difficulties. It underscores the importance of developing a patient safety culture and active learning methodologies to train students for greater commitment and accountability with the quality of care provided to the community in the academic outpatient clinic of the school hospital.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Lista de Verificación/normas , Educación Médica/normas , Cuidados Preoperatorios/normas , Administración de la Seguridad/normas , Procedimientos Quirúrgicos Ambulatorios/educación , Lista de Verificación/instrumentación , Educación Médica/métodos , Humanos , Errores Médicos/prevención & control , Seguridad del Paciente , Cuidados Preoperatorios/educación , Administración de la Seguridad/métodos , Materiales de Enseñanza
3.
Ann Vasc Surg ; 59: 248-258, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31132446

RESUMEN

BACKGROUND: Ambulatory hospitalization for endovascular repair of lower extremity peripheral arterial disease (PAD) could be a real opportunity to respond to the burden of PAD, to reduce costs, and to improve patients' empowerment. The French Society of Vascular and Endovascular Surgery (SCVE) established guidelines to facilitate the development of ambulatory hospitalization in France. METHODS: In 2017, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and MEDLINE database to conduct a systematic review of available literature. A total of 448 relevant articles were found. Twelve articles, all published after the year 2000, were included and reviewed by two independent investigators. The SCVE mandated a scientific committee to collectively establish these guidelines. RESULTS: Eligibility for ambulatory management shall be based on the assessment of the triad: (1) patient, (2) procedure, and (3) structure. Comprehensive information and a detailed procedural pathway should be provided for the patient. No age limit is recommended. American Society of Anesthesiologists I, II, and III stable patients are eligible for ambulatory intervention. Specific comorbidities such as severe obesity, sleep apnea, and/or chronic kidney failure should be assessed preoperatively. Critical limb ischemia and complex lesions have not been considered as exclusion criteria. Antiplatelet drug use (aspirin and/or clopidogrel) has not been considered as a contraindication. Femoral ultrasound-guided puncture is recommended. Manual compression or closure devices have been recommended for 7F sheath or less. A minimum of 4 hours of monitoring after percutaneous femoral access is required before discharge. CONCLUSIONS: The SCVE guidelines aim to frame the practice of ambulatory endovascular procedures for lower extremity peripheral artery disease and to give vascular interventionalists help in their routine practice.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Procedimientos Endovasculares/normas , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Pautas de la Práctica en Medicina/normas , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Toma de Decisiones Clínicas , Consenso , Procedimientos Endovasculares/efectos adversos , Francia , Adhesión a Directriz/normas , Humanos , Resultado del Tratamiento
4.
Anesthesiol Clin ; 37(2): 361-372, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31047135

RESUMEN

Health care professionals see measurement through their own eyes and biases. This article makes the patient central to what is measured. Patient-reported experience measures and patient-reported outcome measures are of the utmost importance. In addition, as clinicians continue to evolve how they measure what really matters, they need to be mindful of the time taken from direct patient care to achieve these activities. In addition, and most important, clinicians must ensure that all measures are designed to ensure that population health is improved, that patient experience and outcomes are enhanced, and that the cost of care is reduced.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia/métodos , Resultado del Tratamiento , Procedimientos Quirúrgicos Ambulatorios/normas , Anestesia/normas , Control de Costos , Humanos , Mejoramiento de la Calidad
5.
J Laryngol Otol ; 133(5): 441-444, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31038097

RESUMEN

BACKGROUND: In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service. OBJECTIVE: This paper presents the new safety standard developed for this purpose and implemented in our institution. CONCLUSION: Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Procedimientos Quirúrgicos Ambulatorios/normas , Endoscopía/normas , Procedimientos Quirúrgicos Otorrinolaringológicos/normas , Administración de la Seguridad/métodos , Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia Local/normas , Anestésicos Locales/uso terapéutico , Endoscopía/métodos , Inglaterra , Humanos , Nariz/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos
6.
Obstet Gynecol Clin North Am ; 46(2): 379-387, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31056138

RESUMEN

The past 4 decades have seen a remarkable re-engineering of health care, particularly with respect to surgical services and the formalization of patient safety protocols. As various forces drove many surgical procedures to the ambulatory setting, many advantages, and perhaps several disadvantages, quickly became apparent. In some studies, adverse events were found to be more common in office settings for instance, and it was quickly recognized that the formal quality controls that had evolved in the hospital setting were not always transferred to the outpatient facility. This article traces the development of health care's response to this challenge.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Procedimientos Quirúrgicos Ginecológicos/métodos , Seguridad del Paciente , Acreditación , Atención Ambulatoria , Procedimientos Quirúrgicos Ambulatorios/mortalidad , Procedimientos Quirúrgicos Ambulatorios/normas , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Femenino , Procedimientos Quirúrgicos Ginecológicos/mortalidad , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Humanos , Errores Médicos/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud , Factores de Riesgo , Resultado del Tratamiento
7.
Rev Esp Cardiol (Engl Ed) ; 72(2): 130-137, 2019 Feb.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29793830

RESUMEN

INTRODUCTION AND OBJECTIVES: The cardiology day hospital (CDH) is an alternative to hospitalization for scheduled cardiological procedures. The aims of this study were to analyze the activity, quality of care and the cost-effectiveness of a CDH. METHODS: An observational descriptive study was conducted of the health care activity during the first year of operation of DHHA. The quality of care was analyzed through the substitution rate (outpatient procedures), cancellation rates, complications, and a satisfaction survey. For cost-effectiveness, we calculated the economic savings of avoided hospital stays. RESULTS: A total of 1646 patients were attended (mean age 69 ± 15 years, 60% men); 2550 procedures were scheduled with a cancellation rate of 4%. The most frequently cancelled procedure was electrical cardioversion. The substitution rate for scheduled invasive procedures was 66%. Only 1 patient required readmission after discharge from the CDH due to heart failure. Most surveyed patients (95%) considered the care received in the CDH to be good or very good. The saving due to outpatient-converted procedures made possible by the CDH was € 219 199.55, higher than the cost of the first year of operation. CONCLUSIONS: In our center, the CDH allowed more than two thirds of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. In the first year of operation, the expenses due to its implementation were offset by a significant reduction in hospital admissions.


Asunto(s)
Centros de Día/normas , Calidad de la Atención de Salud , Anciano , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/normas , Unidades de Cuidados Coronarios/economía , Unidades de Cuidados Coronarios/normas , Análisis Costo-Beneficio , Centros de Día/economía , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Satisfacción del Paciente , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , España , Procedimientos Quirúrgicos Torácicos/economía , Procedimientos Quirúrgicos Torácicos/normas , Procedimientos Quirúrgicos Torácicos/estadística & datos numéricos
8.
Spine (Phila Pa 1976) ; 44(1): 79-83, 2019 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-29894451

RESUMEN

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The aim of this study was to compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement (TDR) surgery. SUMMARY OF BACKGROUND DATA: Cervical TDR is a motion-sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce health care costs are driving spine surgery to be performed in the outpatient setting. As cervical TDR surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006 and 2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data were compared between the inpatient and outpatient cohort using univariate analysis. RESULTS: There were 531 (34.2%) patients treated as outpatients and 1022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts. CONCLUSION: There was no difference between 30-day complications, readmission, and reoperation rates between inpatients and outpatients who underwent a single-level cervical TDR. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting. LEVEL OF EVIDENCE: 3.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/tendencias , Vértebras Cervicales/cirugía , Hospitalización/tendencias , Radiculopatía/cirugía , Enfermedades de la Médula Espinal/cirugía , Reeemplazo Total de Disco/tendencias , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios/normas , Estudios de Cohortes , Bases de Datos Factuales/normas , Bases de Datos Factuales/tendencias , Femenino , Humanos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Mejoramiento de la Calidad/normas , Mejoramiento de la Calidad/tendencias , Radiculopatía/diagnóstico , Reoperación/normas , Reoperación/tendencias , Estudios Retrospectivos , Enfermedades de la Médula Espinal/diagnóstico , Factores de Tiempo , Reeemplazo Total de Disco/efectos adversos , Resultado del Tratamiento
10.
J Surg Res ; 232: 346-350, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30463740

RESUMEN

BACKGROUND: The evolving demands of our current health care system for enhanced efficiency and safety while decreasing hospital length of stay has led to our institutional protocol for same-day discharge (SDD) after laparoscopic appendectomy. We have previously demonstrated a 28% rate of SDD in children with nonperforated appendicitis. The purpose of our study is to assess the effectiveness of a mature protocol for SDD by evaluating discharge success, duration of hospital stay, and readmission rates. MATERIALS AND METHODS: A retrospective review of prospectively collected data was conducted. All children undergoing a laparoscopic appendectomy for nonperforated appendicitis at Children's Mercy Hospital between December 2015 and July 2017 were included. Patients were classified according to whether they were discharged home the same day as their operation or had an overnight stay. Demographic data, time of day the procedure was completed, postoperative length of stay, and readmission rates were abstracted from patient medical records. Comparative analysis was performed in STATA using chi-squared or Fisher exact tests for categorical variables and t-test or Wilcoxon rank sum test for continuous variables. RESULTS: A total of 569 children were included, with 87% (n = 495) discharged home the same day as their appendectomy. Of the patients discharged home the same day of surgery, their median length of postoperative stay was 4 h (IQR: 3, 5) compared with 19 h for the patients who stayed overnight (IQR: 15, 25, P < 0.0001). Approximately two-thirds of patients who had their appendectomies after 6 PM stayed overnight. In addition, patients discharged home the same day had similar hospital readmission rates compared with patients who stayed overnight (2% vs. 4%, P = 0.155). CONCLUSIONS: After laparoscopic appendectomy in children with nonperforated appendicitis, SDD not only reduces postoperative length of stay but also is not associated with higher hospital readmission rates.


Asunto(s)
Apendicectomía/normas , Apendicitis/cirugía , Vías Clínicas , Hospitales Pediátricos/organización & administración , Alta del Paciente/normas , Adolescente , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/normas , Apendicectomía/efectos adversos , Niño , Femenino , Hospitales Pediátricos/normas , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/normas , Tiempo de Internación/estadística & datos numéricos , Masculino , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Periodo Posoperatorio , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Estudios Retrospectivos , Factores de Tiempo
11.
Am J Nurs ; 118(10): 15-16, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30260875

RESUMEN

More than 25 million surgeries are performed each year, yet safety statistics are lacking.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Procedimientos Quirúrgicos Ambulatorios/normas , Personajes , Femenino , Humanos , Errores Médicos , Seguridad del Paciente/normas
12.
Acta Med Port ; 31(7-8): 425-430, 2018 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-30189171

RESUMEN

INTRODUCTION: According to several studies conducted in North America and Europe, ambulatory surgery is a practice that has grown over the years, and both the number of more complex surgical procedures deemed suitable for ambulatory surgery and the number of patients with different co-morbidities which are now suitable for this type of procedure have been increasing. In order to respond to the increased number of day surgeries, as well as to avoid a potential proportional increase in perioperative morbidity, quality control systems must be adopted to enable continuous improvement and minimise predicted risks. The purpose of this study is to review global quality indicators used in ambulatory surgery and compare them with those used in Portugal. MATERIAL AND METHODS: The authors conducted a comprehensive search of medical databases, using MeSH words. Limits were applied to include only studies published after 1998 written in Portuguese, English and Spanish. Ambulatory surgery indicators for Portugal were also obtained. RESULTS: Twenty-one different quality indicators for ambulatory surgery were identified. The Portuguese Healthcare Regulation Authority has defined seven quality indicators for ambulatory surgery. DISCUSSION: The Portuguese quality indicators for ambulatory surgery are generally well adapted to current international practices. Nevertheless, after analysing the relevant international literature based on this study, it is important to consider two additional indicators for ambulatory surgery - same day surgery cancellations and patient satisfaction. CONCLUSION: On the literature review, same day surgery cancellations and patient satisfaction should be included in the National Health Assessment System created by the Portuguese Healthcare Regulation Authority.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Indicadores de Calidad de la Atención de Salud , Humanos , Portugal
13.
Orthop Clin North Am ; 49(4): 541-551, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30224015

RESUMEN

Outpatient total ankle arthroplasty is a potential significant source of cost savings. The ability to institute an effective outpatient total ankle program depends on appropriate patient selection, surgeon experience with total ankle replacement, addressing preoperative patient expectations, the involvement of an experienced multidisciplinary care team including experienced anesthesiologists, nurse navigators, recovery room nursing staff and physical therapists, and most importantly, such a program requires complete institutional logistical support.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Articulación del Tobillo/cirugía , Artroplastia de Reemplazo de Tobillo/normas , Manejo del Dolor/normas , Dolor Postoperatorio/terapia , Humanos , Dolor Postoperatorio/diagnóstico
14.
Eur J Pediatr ; 177(11): 1603-1608, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30058010

RESUMEN

Tonsillectomy is one of the commonest ENT paediatric procedures. Recovery is best achieved at home, and cost-effectiveness of the day case pathway is significant in tonsillectomy. This project scrutinised the local practice regarding the effectiveness of day case pathway in paediatric tonsillectomy in a large regional teaching hospital. The project aimed to improve the rates of day case tonsillectomy discharges, to increase compliance of postoperative care with guidelines, and to assess long-term sustainability of the new practice. The project looked prospectively at the pre-existing paediatric tonsillectomy day case practice (cycle 1) prior to implementing a multifaceted intervention. The intervention consisted of an evidence-based change to local day case tonsillectomy guidelines, improved lists' planning/management, and clinicians' education. Thereafter, the outcomes were measured in the short term (cycle 2-prospective data collection) and in the long term (cycle 3-retrospective data collection). The gathered data revealed an improvement in post-tonsillectomy day case discharge rates (both short and long term), without an increase in postoperative complications. Moreover, our intervention had effectively reduced sleep study requests and resulted in a significant increase in list profitability.Conclusion: The departmental practice in paediatric day case tonsillectomy was improved via evidence-based relaxation of day case criteria, improved list management, and clinicians' education. The interventions resulted also in a positive significant financial impact with no increase in postoperative complications. What is Known: • Tonsillectomy is a common paediatric ENT procedure, with significant applicability and cost-effectiveness of the day case pathway. • There is a lack of a clear general consensus on criteria for patients' suitability for day case tonsillectomy. What is New: • This quality improvement project carried out a methodical relaxation of day case criteria of day case tonsillectomy. • The new criteria along with enhanced list management and clinician education had safely improved the local post-tonsillectomy day case care.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Pautas de la Práctica en Medicina/normas , Mejoramiento de la Calidad/estadística & datos numéricos , Tonsilectomía/normas , Niño , Preescolar , Hospitales de Enseñanza , Humanos , Alta del Paciente/normas , Cuidados Posoperatorios/normas , Estudios Prospectivos , Tonsilectomía/métodos
15.
J Gen Intern Med ; 33(8): 1352-1358, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29869143

RESUMEN

BACKGROUND: Wide variations exist in price and quality for health-care services, but the link between price and quality remains uncertain. OBJECTIVE: This paper used claims data from a large commercially insured population to assess the association between both procedure- and provider-level prices and complication rates for three common outpatient surgical services. DESIGN: This is a retrospective cohort study. SETTING: The study used medical claims data from commercial health plans between 2009 and 2013 for three outpatient surgical services-joint arthroscopy, cataract surgery, and colonoscopy. MAIN MEASURES: For each procedure, price was assessed as the sum of patient, employer, and insurer spending. Complications were identified using existing algorithms specific to each service. Multivariate regressions were used to risk-adjust prices and complication rates. Provider-level price and complication rates were compared by calculating standardized differences that compared provider risk-adjusted price and complication rates with other providers within the same geographic market. The association between provider-level risk-adjusted price and complication rates was estimated using a linear regression. KEY RESULTS: Across the three services, there was an inverse association between both procedure- and provider-level prices and complication rates. For joint arthroscopy, cataract surgery, and colonoscopy, a one standard deviation increase in procedure-level price was associated with 1.06 (95% CI 1.05-1.08), 1.14 (95% CI 1.11-1.16), and 1.07 (95% CI 1.06-1.07) odds increases in the rate of procedural complications, respectively. A one standard deviation increase in risk-adjusted provider price was associated with 0.09 (95% CI 0.07 to 0.11), 0.02 (95% CI 0.003 to 0.05), and 0.32 (95% CI 0.29 to 0.34) standard deviation increases in the rate of provider risk-adjusted complication rates, respectively. LIMITATIONS: Results may be due to unobserved factors. Only three surgical services were examined, and the results may not generalize to other services and procedures. Quality measurements did not include patient satisfaction or experience measures. CONCLUSIONS: For three common outpatient surgical services, procedure- and provider-level prices are associated with modest increased rates of complication rates.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Artroplastia/economía , Extracción de Catarata/economía , Colonoscopía/economía , Costos de la Atención en Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/normas , Artroplastia/estadística & datos numéricos , Extracción de Catarata/estadística & datos numéricos , Niño , Preescolar , Colonoscopía/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Estudios Retrospectivos , Ajuste de Riesgo , Estados Unidos , Adulto Joven
17.
Curr Pain Headache Rep ; 22(6): 40, 2018 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-29725865

RESUMEN

PURPOSE OF REVIEW: We performed a systematic review to elucidate the current guidelines on weaning patients from opioids in the post-operative ambulatory surgery setting, and how pain management intraoperatively can impact this process. DESIGN: The review highlights the most up-to-date research from clinical trials, patient reports, and retrospective studies regarding both the current guidelines and weaning of opioid analgesia in ambulatory surgery setting. RECENT FINDINGS: A striking paucity of convincing evidence exists on ambulatory postoperative pain management discontinuation or weaning of pain medications. However, retrospective and patient-reported studies suggest our approach should be similar to acute pain management strategies. The first steps include identifying high-risk patients and devising an appropriate pain plan. This may be accomplished by implementing multimodal analgesia, anticipating opioid needs, and the proper use of regional anesthesia. The increasing roles for Transitional Pain Service (TPS), Perioperative Surgical Home (PSH), and Enhanced Recovery After Surgery (ERAS) may also guide us in this process. Patients discharged from same-day surgery may lack the additional infrastructure of a hospital or medical establishment to monitor postoperative recovery. As such, weaning of pain medications in ambulatory surgery settings requires teams that are adept at treating varied patient populations through a tailored, novel means that invoke multimodal analgesia. Given the growth of surgeries moving toward the ambulatory sector, more data and practice guidelines are needed to direct postoperative pain regimen titration for the patients.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Analgésicos Opioides/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Rol del Médico , Cuidados Posoperatorios/normas , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/tendencias , Analgésicos Opioides/efectos adversos , Humanos , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/prevención & control , Dolor Postoperatorio/diagnóstico , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/tendencias
18.
J Oral Maxillofac Surg ; 76(8): 1616-1639, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29715448

RESUMEN

PURPOSE: Safety checklists in medicine have been shown to be effective in the prevention of complications and adverse events in patients undergoing surgery. Such checklists are not as common in dentistry. The aims of this study were to propose a safety checklist for the ambulatory treatment of patients undergoing oral and implant surgery and to assess its impact on patient safety and staff satisfaction. MATERIALS AND METHODS: After implementation of a surgical safety checklist in the ambulatory treatment of patients undergoing oral and implant surgeries, a questionnaire regarding staff satisfaction and safety-related parameters was randomly administered. Incidents, complications, and adverse events were documented. Outcomes with (n = 40 surgeries) and without (n = 40 surgeries) use of the checklist were analyzed and compared. RESULTS: Staff reported high satisfaction with the use of the checklist, which demonstrably improved team communication and lowered stress levels during surgery. There was a statistically significantly higher frequency of reported incidents without the use of the checklist (n = 43) than with the use of the checklist (n = 10; P = .000). Most incidents were reported in the context of pre- and post-procedural processes. CONCLUSIONS: Safety checklists help to improve work processes, optimize communication, and lower stress levels. Their use in clinical dental practice is recommended.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Lista de Verificación , Satisfacción en el Trabajo , Procedimientos Quirúrgicos Orales/normas , Seguridad del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Femenino , Humanos , Masculino , Grupo de Atención al Paciente , Estudios Prospectivos , Encuestas y Cuestionarios
19.
Pediatr Surg Int ; 34(7): 755-761, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29808282

RESUMEN

INTRODUCTION: For the past 3 years, our institution has implemented a same clinic-day surgery (CDS) program, where common surgical procedures are performed the same day as the initial clinic evaluation. We sought to evaluate the patient and faculty/staff satisfaction following the implementation of this program. METHODS: After IRB approval, patients presenting for the CDS between 2014 and 2017 were retrospectively reviewed. Of these, patient families who received CDS were contacted to perform a telephone survey focusing on their overall satisfaction and to obtain feedback. In addition, feedback from faculty/staff members directly involved in the program was obtained to determine barriers and satisfaction with the program. RESULTS: Twenty-nine patients received CDS, with the most commonly performed procedures being inguinal hernia repair (34%) and umbilical hernia repair (24%). Twenty (69%) patients agreed to perform the telephone survey. Parents were overall satisfied with the CDS program, agreeing that the instructions were easy to understand. Overall, 79% of parents indicated that it decreased overall stress/anxiety, with 75% saying it allowed for less time away from work, and 95% agreeing to pursue CDS again if offered. The most common negative feedback was an unspecified operative start time (15%). While faculty/staff members agreed the program was patient-centered, there were concerns over low enrollment and surgeon continuity, because there were different evaluating and operating surgeons. CONCLUSION: This study successfully evaluated the satisfaction of patients and faculty/staff members after implementing a clinic-day surgery program. Our results demonstrated improved patient family satisfaction, with families reporting decreased anxiety and less time away from work. Despite this, faculty and staff members reported challenges with enrollment and surgeon continuity.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Citas y Horarios , Procedimientos Quirúrgicos Ambulatorios/normas , Actitud del Personal de Salud , Niño , Circuncisión Masculina/métodos , Femenino , Hernia Inguinal/cirugía , Hernia Umbilical/cirugía , Herniorrafia , Humanos , Masculino , Satisfacción del Paciente , Estudios Retrospectivos , Enfermedades de la Piel/cirugía , Hidrocele Testicular/cirugía , Factores de Tiempo
20.
Otolaryngol Head Neck Surg ; 159(1): 136-142, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29737927

RESUMEN

Objective To review complications of in-office endoscopic laryngeal laser procedures after implementation of standardized safety protocol. Methods A retrospective review was conducted of the first 2 years of in-office laser procedures at St Michaels Hospital after the introduction of a standardized safety protocol. The protocol included patient screening, procedure checklist with standardized reporting of processes, medications, and complications. Primary outcomes measured were complication rates of in-office laryngeal laser procedures. Secondary outcomes included hemodynamic changes, local anesthetic dose, laser settings, total laser/procedure time, and incidence of sedation. Results A total of 145 in-office KTP procedures performed on 65 patients were reviewed. In 98% of cases, the safety protocol was fully implemented. The overall complication rate was 4.8%. No major complications were encountered. Minor complications included vasovagal episodes and patient intolerance. The rate of patient intolerance resulting early termination of anticipated procedure was 13.1%. Total local anesthetic dose averaged 172.9 mg lidocaine per procedure. The mean amount of laser energy dispersed was 261.2 J, with mean total procedure time of 48.3 minutes. Sixteen percent of patients had preprocedure sedation. Vital signs were found to vary modestly. Systolic blood pressure was lower postprocedure in 13.8% and symptomatic in 4.1%. Discussion The review of our standardized safety protocol has revealed that in-office laser treatment for laryngeal pathology has extremely low complication rates with safe patient outcomes. Implications for Practice The trend of shifting procedures out of the operating room into the office/clinic setting requires new processes designed to promote patient safety.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Laringoscopía/normas , Seguridad del Paciente , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Adulto Joven
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