Surgery: it takes

Surgery: it takes a million acts more as an outpatient by 2022

This is where the key to the future of the hospital, according to health authorities

“Ambulatory surgery is at the crossroads of medical practices, technologies and organizations”, explains the boss of the French hospitals, Cécile Courrèges, director-general of the DGOS (Directorate general for healthcare provision). According to her, it is even “one of the dynamics of transformation of our system of care is emblematic of the innovation in this sector.”And for good reason. It should be a faultless order to be able to surgical procedures in the safety of an operating room, under anesthesia of the mode variable and followed by a postoperative surveillance for risk-free plus the output of the patient on the same day of his speech”, to borrow a definition from 1993. Do the outpatient surgery requires an institution to be excellent in every step of the way clinical patients. The entrance to the hospital to live at home and in the days that follow the operation, through the circuit in the establishment of care and, of course, the surgical act itself. “The patient satisfaction must be a priority at all levels,” explained professor Corinne Vons, president of the French Association of ambulatory surgery (Afca), which held its national days on 10 and 11 January in Paris. “If we let the hospital facilities as they are today, we’re never going to” Dr.

. Guy Bazin, founder of the AFCA The former minister of Health, Marisol Touraine, had set a target of 66. .2% of surgical procedures in an outpatient setting in France in 2020. Ambitious, since the estimated rate in the first eight months of 2016 was only 54 %, with an annual growth of 2. .2 % (it is finally established to 54. .3 %), where the necessary growth was 2. .9 % per year. New minister, new goal. Last October, Agnès Buzyn, set the new cap to “70 % by 2022”, during Interviews of Bichat.

Denmark and Sweden have already reached 90 %, but we should be wary of international comparisons, because the systems are often very different. There remains, however, that when we look at surgical procedure by surgical procedure, the late French persists in relation to our neighbours, the nordic in particular. “In France, in 2017, in the first seven months of the year, the rate of ambulatory surgery has been 2.

.5 percentage points compared to 2016, to reach to 56. .8%, ” announced Wednesday, Cécile Courrèges. Suffice to say that the goal set by Agnès Buzyn seems achievable.

Provided that the public sector was committed to the frankly. Because if the shift to the outpatient setting is done quickly in the private sector, the public sector has lagged far behind.

In 2015, whereas the overall rate of ambulatory surgery was 56. .1 per cent in the private sector-profit, the national rate was only 43 %. . Leaded by the public sector in general and hospitals in particular. “The greater diversity of the stays related to public service obligations, as well as a method of financing long little incentive to the development of this mode of support, partly explain the delay in the public sector (35,6 %), in particular in the structures of type CHU”, explained the health Insurance two years ago.

Engage public stakeholders in developing modes of financing incentives is a prerequisite, of course. But this was not enough. “The relevance of the soinsdoit be at the heart of all our actions”To convince the surgeons are still reluctant to act, the Afca update on “the appropriateness of care,” says the Pr Vons, must be at the heart of all our actions. ” The Afca has been charged by the DGOS to prepare a report on the outpatient surgery in public institutions and groupings, hospital territory.

The new philosophy of health Insurance is to go “towards a more medicalised”. It is true that Gilles Bontemps, director of the CNAMTS, has made its accounts: “If one wants to achieve the rate departmental displayed 70 % in 2022, it is necessary to switch a million surgical procedures carried out today in hospitalizations acts performed in an outpatient setting. ” This means clearly do where potential lies: in the CHU.

Through the development of centres self-sustaining, designed for ambulatory surgery.

But it is another track that the authorities have so far refused to explore resolutely. The one to authorize the opening of independent centres, fully dedicated to outpatient surgery.

“It is the choices made by the country in which the ambulatory surgery was developed, note Dr. . Guy Bazin, one of the French pioneers, founder of the Afca. If one leaves the hospital facilities as they are today, we will never do that. “In a few weeks, the institutions will be able to compare finely with their potential for conversion to ambulatory surgery thanks to a new tool of the health Insurance.

The wake up risk to be severe for some institutions.

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