Ambulatory surgery Flashcards
Goals of ambulatory surgery include
convenience and cost savings to patients, their families and the surgeons
The first ambulatory surgery centers were opened in
Phoenix by Dr. Wallace Reed & Dr. John Ford
Patient goals and expectations at ambulatory surgical centers:
patients expect safe care, excellent pain relief, absence of nausea and ability to return to normal daily routines as quickly as possible
- safety during anesthesia
- no harm will occur during surgical experience
- comfort in hours/days after surgery
- not to be a burden to families and friends
When patients go home after ambulatory surgery, it is important to advise them to
not do drugs, drink alcohol, or sign any important documents for 24 hours
The focus for anesthesia in the ambulatory setting is
selection criteria for cases and patients that create a predictable environment
- attention to safety that exceeds that applied in hospital setting
- careful monitoring of patient outcomes and best practices
- consistently leave patients clear-headed and as free of nausea and pain as possible
- codification of best practices into “standard work”
The goal for patient, procedure, and practitioner selection is to achieve
predictability, consistent and directive guidelines**
requires collaboration of surgeon, facility & anesthesia providers
RNs in an ambulatory center should have
ACLS, PALS
Safety in the ambulatory setting is huge and involves
code cart, MH, LAST, difficult airway
frequent simulation exercises
Describe the advantages of outpatient surgery.
financial, medical, patient satisfaction, social, & staffing
Describe the financial benefits of outpatient surgery.
economic benefit for consumers, third-party payers, and medical facilities
- reduced medical cost and “life costs” (daycare, return to normal function)
- cost savings exceeding 50% reported for lap chole performed on outpatient basis
- ambulatory centers operate more efficiently than hospital-based ORs in regard to surgical volume
Describe the medical benefits of outpatient surgery.
- increased availability of hospital beds for patients who require hospital admission
- patients who are susceptible to infection can have reduced time and contact in inpatient hospital setting
- decreased risk of nosocomial infection
Describe the patient satisfaction advantage of outpatient surgery.
shorter wait times & lower costs
reduced delays due to lack of beds
Describe the social advantages of outpatient surgery.
children may have less separation from parents
- geriatric patients may have better cognitive and physical capacity when separation is minimized
- POCD decreased in outpatient procedures- less medication and return to familiar environment sooner
Describe the staffing advantages of outpatient surgery.
more efficient use of time
uniform work schedules
more predictable surgical outcomes
Disadvantages of outpatient surgery include
patient privacy may be less than inpatient setting
patient may have to make multiple trips to physician offices/ambulatory setting for eval & screening
adequate home care must be arranged
children have less time to adapt to surgical settings
monitoring time for adverse events are decreased
management of complications can be problematic due to lack of resources
Monitoring outcomes for the outpatient surgery center include
postop calls on day after procedure
improve care & safety
provide assistance if there are postop problems
ideal environment for safe, efficient, low-cost practices
<1% of ambulatory cases result in
unanticipated hospital admission for ambulatory cases
The proposed surgery should have
insignificant incidence of intra & postoperative problems
also requires appropriate surgeon skills and cooperation
The patient should be ____ prior to surgery
his/her usual health & stable for 3 months before surgery
For patients with acute substance abuse in the ambulatory settings
evaluate before surgery
acute intoxication is inappropriate for ambulatory surgery due to impaired autonomic and cardiovascular responses
-regional and local are good techniques
Most perioperative complications occur in
20 to 49 year olds***
Describe how age affects selection criteria in the ambulatory setting.
children <2 have higher unanticipated hospital admission rates due to apnea & bradycardia
premature infant is inappropriate for outpatient surgery
full term infants can be considered for minor outpatient surgery
Describe considerations for the patient with seizure disorder
schedule early in day to observe 4-8 hours postop before discharge
Describe considerations for the patient with cystic fibrosis.
protective airway measures d/t risk of GERD & pulmonary aspiration
Describe MH susceptibility for the patient presenting to the ambulatory setting.
stocked MH cart, dantrolene, activated charcoal filter to reduce VA concentration to less than 5 ppm in 2 min.
Describe special considerations for the obese patient.
an increase in adverse postop outcomes in patients with BMI 44 kg/m2
Describe special considerations for the patient with OSA.
bring CPAP, minimize benzo/opioid use
Preop evaluation and testing includes
review patient’s medical and social history
physical exam- airway, lungs, heart
clinical history drives the preop eval
elimination of routine preop testing
patients of any age can receive outpatient anesthesia
An ECG is indicated for
patients over 65 years of age, or history of CHF, MI, angina, high cholesterol, valvular disease or family history of sudden death
If there is not history of unstable disease, there is
NO NEED FOR ROUTINE testing
unless: family history sudden death, potential for blood loss, contrast dye, potential pregnancy
High risk patients should be evaluated
1 week before
Preoperative considerations include
patient orientation
patient screening should take place sufficiently in advance of scheduled surgery
H&P available before surgery performed
lab tests and dx procedures are deemed current if performed within 6 months of surgery***** if patient’s physical condition remains stable
The most common ambulatory procedures include **
endoscopy & ophthalmologic
