Original Title: Cirugía mayor ambulatoria en Osakidetza / Servico Vasco de Salud

Authors' objectives: Analyse the variability in the use of major surgery performed in the health centres of Osakidetza, determine the opinions of the professionals involved and make recommendations for the development of health centre surgery.

Authors' results and conclusions: In the Osakidetza network as a whole, it can be said that the level of surgical operations actually performed in health centres compared to those that could, potentially be carried out was, in general, medium to low, except in the case of cataracts and adenoid operations, over 90% of which are performed in health centres. With regard to the analysis of general tendencies, there was a gradual and continuous growth in the number of surgical procedures performed in health centres over the last four years. On analysing and comparing the percentages per centres, significant variations in almost all the processes studied were observed. Major differences were found when analysing the attitude of different groups to health centre surgery. While almost all the administrators and co-ordinators of the outpatients surgery units considered that it is a positive option both for patients, professionals and administrators, there was a significant percentage of clinics that considered that health centre surgery was negative for both patients and professionals. The high percentage of professionals who consider that the practice of health centre surgery might bring more problems of a legal nature than surgery involving the admission to hospital of the patient was remarkable. Responses to the survey showed that there were no common clinical criteria with regard to the selection of patients and pathologies suitable for dealing with in health centres. This inconsistency of clinical criteria was perhaps the main reason for the variability found in the percentages of processes dealt with in the health centre of different hospitals. The individual organisational characteristics of each centre would explain another major aspect of this inconsistency. Organisational factors include the time-tabling of surgical operations, the dynamics of the teams in each individual hospital are considered to be key issues, and the co-ordination between the different groups involved is of great importance. The role of the patient-requested appointment service, which might be a key issue is controversial as in many operations that can be performed in health centres there are waiting lists and patient-requested appointment programmes. On the one hand, it enables administrators to negotiate specific conditions such as providing the treatment in a health centre, but on the other hand, as this is currently done in the afternoons, this requires that in certain cases patients be admitted to hospital in order to guarantee an appropriate postoperative treatment.

Authors' recommendations: ƒ Develop and maintain mechanisms to analyse the variability of clinical practice between different centres, and disseminate this information. ƒ Determine and analyse the development of health centre surgery in other contexts and/or health systems. ƒ Promote meetings in each specialist field to foster and encourage joint analysis of the variability of the clinical practice found, among professionals in the same specialist fields in different hospitals. ƒ Foster meetings in each hospital among clinics of different specialities and managers, officers of Surgery with Admission Units and Home Hospitalisation to analyse the characteristics of an organisational nature or other type that might have an important influence on the chances for the performance surgical processes in each health centre. ƒ Favour the development of common protocols for every process that might be performed potentially by health centres in the Osakidetza network as a whole, as well as specific training activities such as courses or periods of work in centres of recognised prestige in new techniques or in ways of organising health services. ƒ Analyse throughout the Osakidetza network the reasons why the vast majority of professionals who consider that major health centre surgery may create more problems of a legal nature than surgery with admission to hospital, and propose initiatives in order to promote the protection of professionals. ƒ Test the hypotheses arising from the opinions obtained in surveys of professionals. ƒ Develop measures to improve the information for patients and family members about major ambulatory surgery. ƒ Analyse the current situation with a study of the costs of different health alternatives and a system of establishing priorities when developing and implementing these in the centres. ƒ Assess in each specific centre the interest in increasing the resources and the operational capacity of the Day Hospital units.

Authors' methods: The first survey analyses the variability in the performance of surgical processes in health centres of the Osakidetza network and for this purpose a study is made of information contained in the Basic Set of Minimum Data on Hospital Admissions and of the P.M.C.’s of Osakidetza hospitals. Data is gathered on the actual rates of health centre surgical interventions compared to the potential number for each hospital, speciality and process and an analysis is made of the development of these rates between 1995 and the first six months of 1998. The second study is a survey aimed at all professionals who belong to a series of groups involved in health centre surgery, whereby it is intended to determine their opinion with regard to several factors that influence the implementation and development of day surgery in the Osakidetza network. The results of the survey have been discussed by a research team in order to identify key elements with a view to drawing up a number of recommendations.

Project Status: Completed

Year Published: 2000

URL for published report: https://www.euskadi.eus/contenidos/informacion/2000_osteba_publicacion/es_def/adjuntos/2000/d_00_11_cirugia_mayor.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>