OFFICE DAY CARE THERAPEUTIC PROCEDURES IN GYNAECOLOGY A ONE YEAR STUDYDR KAVITA PRIYA MD CENTRAL HOSPITAL DHANBAD

MARCH 2011FEBRUARY 2012

TIME FRAMEWORK

In-Office Procedures Office procedures are surgical procedures which may be performed in a clinic or outpatient setting. In-Office Procedures allow the patient to resume her normal activities the next day. General Anaesthesia is not usedCochrane Library 2009

The term day surgery, or ambulatory surgery, refers to the practice of admitting into hospital on the day of surgery carefullyselected and prepared patients for a planned, non-emergency surgical procedure and their discharge within hours of that surgery

DAY CARE SURGERY

DAY CARE SURGERYThe father of day care surgery was James Nicoll, a Glasgow surgeon who performed almost 9000 outpatient operations on children in the early 19th century.

DAY CARE ONE END OF THE SPECTRUM OF SHORT STAY SURGERY

SHORT STAY SURGERY

DAY CARE PROCEDURES PATIENT IS DISCHARGED WITHIN A DAY

ADMISSION TO DISCHARGE INTERVAL

24 - 72 HOURS

OFFICE THERAPEUTICSDAY CARE SURGERY

CONS 1) NEEDS SPECIALIZED TRAINING 2)MINIMALLY INVASIVE EQUIPMENT 3) CUTTING EDGE TECHNOLOGY

OFFICE DAY CARE

4) HEAVY INITIAL OUTLAY 5) RISKY IN LOW RESOURCE SETUP 6) INADEQUATE SURVEILLANCE

7) Need for a responsible person to oversee the day care patient at home for 24-48 hours. FALLBACK 8) Surgery restricted to experienced seniors; less opportunity for juniors.

9) Extra work for the busy GP whose patients keep ringing in the postop period 10) Less cost effective when the unit deals with less complex cases on a BUSY GP day basis

PROS 1)Minimal invasion 2)Reduced pain 3)Less disruption of patients personal lives 4)Minimal anaesthesia 5)Early recovery in home with family

6) Less nosocomial infections 7) Reduced in-patient waiting lists

8) Increased availability of busy hospital beds 9) Reduced costs

10) Financially lucrative for doctor

WHAT PATIENTS WANT.

I WANT TO GO

HOME !!!

I WANT TO GO

HOME !!!

I DONT WANT TO STAND IN LINE ANYMORE!

HOW TO CUT COSTS ???

MINIMAL ANESTHESIA

ZERO PAIN

WHAT DOCTORS WANTUP TO DATE OFFICE/HOSPITAL

TECH KNOWHOW

MONEY

OFFICE DAY CARE IS USER FRIENDLY PATIENT FRIENDLY

OFFICE DAY CARE THERAPEUTIC PROCEDURES FORM A HEALTH CARE DELIVERY MODULE WHICH SUITS PATIENT & DOCTOR ALIKE

DAY CARE SURGERY IS

MONEY MATTERS

COST EFFECTIVECANCELLED

Spares inpatient beds

Less staffNo waiting More output

MONEY MATTERS - AND HOW!! USA SAVING OF 15-30% UK SAVING OF 40% INDIA COST OF PATIENT OCCUPYING BED IN CENTRAL & GOVT. HOSPITALS IS RS.800-900 PER DAY, RS1000 PER DAY IN HIGHER CENTRES LIKE PGIMER CHANDIGARH

OFFICE DAY CARE GYNAECOLOGYTHERAPEUTIC PROCEDURESMARCH 2011 FEBRUARY 2012

OFFICE DAYCARE GYNAE IN MY SET-UP

1)Treatment of abnormal uterine bleeding 2)Sterilization 3)Removal of endometrial polyps 4)Removal of submucous leiomyomas 5)Removal of adhesions caused by infections or past surgeries 6)Insertion & Removal of IUCD 7)Cervical Biopsy

D&C

MYOMA

DUB

POC

OFFICE HYSTEROSCOPE OPERATIVE

OFFICE HYSTEROSCOPY1) Direct Visualization2) Directed biopsy

DILATATION & CURETTAGEBlind Procedure

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