Dr.kavita Priya Iicm 1
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Transcript of Dr.kavita Priya Iicm 1
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
60%