Walk-in, Walk-out Surgery Keeps Patients Out Of Hospital

New Technology, Insurance Drive Increase In Services

February 03, 1991|By Greg Tasker | Greg Tasker,Staff writer

Dr. John Steers practices good medicine by making sure his staff calls patients at home the day after surgery.

These patients, of course, are outpatients -- those who walked into the ambulatory room at Carroll County General Hospital for minor surgery in the morning and returned to the comforts of home later in the day.

"These patients should still be cared for and are always called the next day by the nursing staff," said the general surgeon.

The calls serve as the modern-day equivalent of house calls.

Outpatientsurgery has become more common at hospitals across Maryland and the nation as cost-conscious health insurance companies strive to containexpenses, and advances in medical technology make many surgical procedures more efficient and less likely to require extended patient care.

"There are a number of procedures in which insurance companies will no longer pay for a patient to be hospitalized overnight," said Joan Spear, director of peri-operative services at CCGH.

Hernia operations, which used to require at least an overnight stay, now are one in which a patient can "come in the morning and leave the same day," she said.

Another procedure that has become a routine ambulatory operation in recent years is a D&C -- dilation and curettage -- commonly performed on women with gynecological bleeding problems.

"It's so common that those procedures are ambulatory now," Spear said. "A number of years ago a patient having a D&C would have stayed overnight."

Letitia Dayhoff of Taneytown recently underwent -- as an outpatient -- a cataract operation, a surgical procedure that once required at least an overnight stay. Technological advances have pressed that change.

The 66-year-old retired seamstress entered CCGH in themorning and left the ambulatory care unit by 4 p.m. with a patch over her eye. She was scheduled to visit her doctor the following morning and said she would receive care from family members at home.

"I feel fine," she said. "I do feel a little weak if I move around too much because I haven't eaten since yesterday. It was a simple operation, and I'm ready to go home."

Whether minor surgical procedures receive outpatient or inpatient status sometimes depends on a patient's health insurance, Spear noted.

Beginning this month, for example, Columbia-Free State Health System will pay for myelograms -- a procedure to inspect the spinal cord -- on an outpatient basis only.

"That was previously done on at least an overnight stay," said Denise Noll, Columbia-Free State Health System's director of managed medicalservices. "Now, we're saying we'll pay for this only on an outpatient basis."

Noll, who also is a registered nurse, said the procedure, like many others done on an outpatient basis, can be done effectively and safely. Many physicians, she noted, now perform myelograms on an outpatient basis.

Outpatient status for minor surgery is not something that is written in stone, though, she said.

"The thing that has to be considered in outpatient care is whether a patient has tobe in the hospital subsequent to these procedures and whether the patient is going to be perfectly fine recuperating at home," Noll said.

Although outpatient surgery does save insurance companies money, there are still other costs associated with ambulatory care, she said. They include medication, physician visits and follow-up visits.

"There are savings to be realized," she said. "But with many of theseprocedures patients generally get better faster and are more comfortable at home," Noll said.

Columbia-Freestate will pay for inpatient surgery on minor operations under certain circumstances. For instance, if a woman was in the hospital delivering a baby and had to have a D&C as a result of that procedure, the insurance company would cover the costs, she said.

In other scenarios, she said, "It's a matter of whether medical reasons justify admitting a patient to the hospital."

Occasionally, Steers said, ambulatory patients do require a longer stay because of slow recovery from anesthesia or from problems associated with age. Medical problems require the patient to stay for overnight observation.

Surgeons, he said, are very aware of insurance companies' sensitivity about curbing unnecessary inpatient care.

"They've insisted that minor surgical problems be treated as outpatient care, and rightfully so," he said. "But there are a number of factors leading to more and more outpatient procedures."

He saidbetter pre- and post-operative care also has abetted ambulatory care. Both Spear and Steers said they believe patient education is very important, especially for those receiving anesthesia.

"Since the patient isn't there the night before, the patient must understand that he or she may not have food or water for some time before coming in,"Spear said. "You also want to make sure they've made plans to go home afterward and that there is someone there to care for them."

Steers said his nursing staff's calls to patients the day after their outpatient surgery have been well received by his patients.

"Patients appreciate that very much," he said. "It's good medicine. Some people are reticent or sensitive about calling the doctor back. They might think something is minor, but it could be something that needs attention."

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