Ambulatory Surgical Setting Research Articles

QUALITY IMPROVEMENT IN THE AMBULATORY SURGICAL SETTING

Quality improvement is considered part of "business as usual" in the health care field. Some institutions have progressed further into their quality improvement efforts than others. Nonetheless, there is always the opportunity to learn from the efforts of others and to adopt their methods for use in one's own setting when possible. Included in this article is a case study outlining the use of the FOCUS PDCA methodology for quality improvement. The information identifies ways of introducing and beginning quality improvement efforts in a way that can be translated into other ambulatory health care settings.

Transnasal butorphanol tartrate for pain control following ambulatory surgery

Thirty patients who had undergone laparoscopic Yoon fallopian ring sterilization, laparotomy tubal sterilization, arthroscopy with meniscectomy, inguinal herniorrhaphy, or rectal surgery and who had moderate to severe postsurgical pain were enrolled in an open study conducted in an ambulatory surgical setting. Over a 3-day period after discharge from the surgical unit, patients self-administered transnasal butorphanol tartrate 0.5 mg under a flexible dosage regimen. Before surgery, patients were trained on the proper use of the nasal spray device for administering transnasal butorphanol. At the clinic before discharge, measurements of analgesia and safety were made at specified intervals. At discharge, patients were given a diary to record daily the number and time of drug administration, any adverse experiences, and global assessment of pain relief. At the clinic, 50% relief from baseline pain was achieved for the 30 patients after a mean total dose of 1.07 mg had been administered. The average time to 50% relief was 1 hour after the initial 0.5-mg dose. Of the patients who required analgesia at home, transnasal butorphanol provided satisfactory pain relief for 79% of the patients on day 1, 95% on day 2, and 91% on day 3. Adverse experiences were reported by 70% of the patients on day 1, with dizziness, nausea, and drowsiness, being the most frequent. On day 2, 36% reported such experiences, with headache and dizziness being the most frequent. Of the 11 patients who required medication on day 3, only one reported an adverse experience (sneezing). None of the adverse effects were serious. The results from this study support the usefulness of transnasal butorphanol in an ambulatory surgical setting for the management of pain when the use of an opioid analgesic is appropriate.

Outpatient Hemorrhoidectomy

Fifty-three patients underwent closed hemorrhoidectomies on an outpatient basis at the Naval Hospital Bethesda, Bethesda, Maryland, and George Washington University Hospital, Washington, DC. Our goal was to show that closed hemorrhoidectomies could be tolerated well in an outpatient setting. We found that patients tolerated this surgery well, and there was no progression of complications due to the out-of-hospital setting. An additional benefit is the cost savings to the patient who does not require an overnight hospitalization. Outpatient hemorrhoidectomy is a technique that can be effectively used in an ambulatory surgical setting with good patient tolerance and acceptance.

The Selection of Drugs in Office Surgery

The aim of this article is to suggest a rational, effective, and safe drug regimen that will satisfy the needs of both patients and surgeons in an outpatient ambulatory surgical setting. Commonly used drugs and local anesthetics are discussed.