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3Rd International Congress on Ambulatory Surgery April 25–28, 1999

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3Rd International Congress on Ambulatory Surgery April 25–28, 1999 Ambulatory Surgery 7 (1999) S1–S108 Abstracts 3rd International Congress on Ambulatory Surgery April 25–28, 1999 suitable and consistent information about the disease, its treatment Organization and Management and possible consequences both of the disease and of its treatment. Lack of information can make the contract null and void causing a physician to act against the law. For the consent to be valid it has to Severity of symptoms following day case cystoscopy be given by a Subject in full possession of his/her faculties or aged to be as such. The surgeon’s obligation so established in the contract is M Cripps the obligation of means or diligence in his/her performance and not Lecturer Practitioner, Day Surgery Unit, Salisbury District Hospital, an obligation to results. A surgeon therefore acts within the limits of Wiltshire, England a behaviour obligation and not of an obligation to results. Neverthe- less this is an apparent distinction, as a fact, considered as a mean in INTRODUCTION: This is the result of a collaborative study under- respect of a subsequent aim, will be a result when assessed as such, taken by six Day Surgery Units around South West England looking and as the final stage of a limited sequence of facts. at the morbidity following day case cystoscopy. Critical management factors (CMF) in an ambulatory surgery center METHODS: The study investigated, through patient questionnaire, the patients’ experience in the first 48 hours post surgery of pain, RC Williams sickness, presence of haematuria, burning on micturition, frequency of micturition and contacts with health care professionals. There was Federated Ambulatory Surgery Association, Washington, DC. USA also opportunity for the patient to provide feedback on their INTRODUCTION: Ambulatory Surgery Centers (ASC) are expen- experience. sive to build and operate and are frequently reimbursed less than RESULTS: 10% of patients experienced unsatisfactory amounts of hospitals providing the same or similar services. Therefore, to meet or pain. The majority of patients experienced burning on, and frequency exceed profit expectations, ASC’s must be managed efficiently. Expe- of, micturition. Comparisons were made between grade of surgeon, rience in developing and/or managing more than fifty ASC’s has sterilisation techniques of equipment, whether the patients were pre demonstrated that there are fifteen Critical Management Factors assessed or not and quality of patient information. (CMF) that, when complied with, will ensure the ASC operates in an CONCLUSION: Collaborative studies such as this enable sharing of efficient, effective and profitable manner. information to ensure best practice is disseminated through many METHODS: Through the aforementioned experience, certain values centres. Individual Units that took part are receptive to recommenda- and ratios have been established that have become recognized as tions and a local Senior Nurses Interest Group has arisen from this performance benchmarks or CMF. These CMF will vary slightly, project to enable further collaborative work. depending upon the cost structure of the ASC, and are established during the annual budgeting process. Once established, comparing Principles of civil liability as regards knowledgeable consent the CMF to actual performance will clearly point out those areas FM Donelli where management needs to focus its attention in order to meet or exceed budgetary expectations. These performances benchmarks, or Via A. Mario 32, Milano 20I49, Italy CMF provide a detailed measurement of patient volume, revenue, staffing costs and ratios, supply cost per case, total expenses, accounts A surgeon’s work is liable to the principles of civil law stating the receivable analysis, income and profit margins. duties of brainwork employees and of criminal law as regards a RESULTS: CMF represent to a good ASC manager what a patient’s culpable behaviour. Various stages of professional responsibility orig- vital signs represent to a physician. With a good CMF protocol, an inate from a breach of the rules in the relationship between a ASC manager can identify areas of managerial concern, without ever physician and his/her patient. Assumption of this contract relation- looking at the financial report or speaking with either employees or ship is the capacity to engage so as to make the contract valid and staff physicians. The beauty of a good CMF process is that it lawful. Consequently a basic condition to a contract-relationship provides a busy manager, or physician owner, with a ‘‘snap shot’’ of regarding medical matters is a KNOWLEDGEABLE CONSENT, the ASC’s over all performances, and areas of concern, without e.g. the declaration by which a patient intends to bring about a having to look any further. relationship generating on the other side an obligation to treat and on CONCLUSIONS: To efficiently and effectively manage an ASC in his/her side the obligation to be treated. In order to be aware of it a the future, particularly in view of lower reimbursement, will become patient must know the content of possible consequences to be ex- increasingly more difficult and time consuming. Proven management pected; it means that for a contract to be valid it requires basically the tools, such as well established CMF process, will dramatically im- 0966-6532/99/$ - see front matter © 1999 Elsevier Science B.V. All rights reserved. PII: S0966-6532(99)00015-3 S2 Abstracts prove the manager’s and owner’s ability to ensure the center oper- ambulatory surgery, surgeons usually restrict themselves to determi- ates in a manner that meets the expectations of all involved. nation of the type of operation, and leave other items to nurses and anaesthetists. We were of the opinion that proper patient selection The effect of the day surgery experience on the quality of life and and preparation for day surgery required a more intensive surgical psychological well-being of the patient: an assessment of patients’ participation and arranged a consultation with a specialised surgeon perceptions of health on the day of anaesthesiological pre-assessment, 4–6 weeks before AM Coll, C Torrance, L Moseley scheduled surgery. The usefulness of this procedure was analysed. METHODS: Retrospective analysis of cases presented for surgical Department of Nursing Research, Uni6ersity of Glamorgan, Pon- preoperative assessment. typridd, South Wales CF37IDL, Great Britain RESULTS: From 01–01–‘97 till 30–06=’98 a total of 486 pa- tients, after consultation with their surgeon, received an appoint- INTRODUCTION: An attempt to establish patients’ perceptions of ment for surgical and anaesthesiological pre-assessment as health status before and after their day surgery experience using a day-surgery was found indicated. Of these patients, 24 (5%) never postal questionnaire one week before and two weeks afterwards. An appeared. Eighty-one (17%) patients were found unsuitable for am- attempt to measure the quality of life of patients, establishing the bulatory surgery, and 14 (3%) patients, after proper information, degree of impact experienced by the patient before and after surgery renounced surgery. From the 81 patients found unsuitable for am- in all areas of daily living. It is the extent of the alteration in their bulatory surgery, 27 were rejected for anaesthesiological reasons, all daily functioning, particularly in the post operative period that we others for surgical reasons: surgical treatment not indicated, sug- hope to establish. gested operation to much time-consuming for an ambulatory proce- METHODS. Three day surgery units throughout Great Britain. The dure, etc. A total of 367 patients was eventually scheduled for an full study involves a consecutive sample of 900 patients (300 from ambulatory procedure, from which 20 (5%) did not appear on the each centre) based on three surgical procedures: laparoscopic sterili- day of surgery, and 11 (3%) had to be clinically admitted after sation; hernia and varicose vein surgery. The data has been gener- surgery. ated by Formic (questionnaire design package and scanner and CONCLUSION: Surgeons should be more actively involved in the analyst facility) and SPSS. Five health assessment tools were se- selection and preparation of patients for ambulatory surgery. There lected: SF36; Health Locus of Control; Satisfaction with Life scale; even might be a need for specialisation in this field. It was disap- Duke-UNC Social Functional health profile and visual analogue pointing to notice that despite this thorough preparation the num- scales. ber of no-shows was inacceptably high. RESULTS: To date over 600 patients have been recruited and the interim findings will be reported on a discussion of: general health Federated Ambulatory Surgery Association Outcome Survey perceptions; physical functioning; symptom distress; psychological CH Beeler distress and limitations in social and role functioning both pre and post operatively. President, FASA, Alexandria, Virginia, USA CONCLUSIONS: It is anticipated that this research study will SURVEY DEVELOPMENT PROCESS make a significant contribution in: the development of a greater informed and participative relationship with the patient; provide a * Question Selection more accurate assessment of patient outcomes in day surgery during the first two weeks and provide scope for a more unified approach * Refining Question Definitions for the measurement of quality of life. * Determining Definition and use of confounding factors RESEARCH AND EXPLORATION Organisation of a day-surgery unit based on quality
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