Continuity of care in ambulatory surgery: what are the obstacles?

Abstract

Background: Over the last decennia an increasing number of patients is undergoing surgery on an ambulatory basis in a surgical day hospital. This evolution is financially beneficial and relieves the load on the hospitals, but the pressure on the primary care systems may increase. We undertook a survey to determine which problems primary care physicians encounter before and after their patients undergo surgery in the surgical day hospital, which factors affect the quality of communication between primary care physicians and hospitals, and to gather suggestions from primary care physicians to streamline the process of ambulatory surgery.

Methods: All identified primary care providers received a questionnaire by e-mail. The questions were formulated by experts in the field, based on their own experience and literature data. Answers where either categorized into categorical lists or where tabulated for the open questions. No formal statistical analysis was performed on the categorical results as this is a descriptive study.

Results: During the preoperative phase, primary care physicians indicate that they are often unaware or not timely informed when their patient will undergo ambulatory surgery. This leads to problems in organizing preoperative investigations and arrangements for postoperative care. Primary care physician’s stress the importance of correct communication between them and the surgical day hospital including being timely alerted of patient discharge, receiving sufficient information about complications, interventions and postoperative advice. A number of improvements are suggested to address these issues.

Conclusions: This survey prompts reflection of our local practice but proved to be a useful tool in identifying problems in the continuity of ambulatory surgical care. Communication between hospital care givers and primary care physicians seems to be a major issue and needs to be addressed.