Background and Goal of Study:Ambulatory surgery is gaining popularity. In that setting, lean management methodology has the potential to improve patients’ turnover. In this perspective, at our institution, a specific circuit (SC) has been set up for ambulatory hand surgery patients. Compared to conventional circuit (CC), patients in SC receive a specific information leaflet, stay in armchairs instead of beds, are cared by a specific nurse, are given meals adapted to unassisted patients and receive postoperative instructions by the surgeon at the end of surgery before exiting operating room (OR). The objective of this study was to evaluate the effects of this approach on patient cycle.
Materials and Methods:For this retrospective cohort study, we used data from 30 SC patients undergoing hand surgery under axillary blockade. To exclude risks of confounding factors, we also used data from 60 patients of CC matched for age, type of anesthesia and expected duration of surgery. Additional data collected included ASA score, time of appointment, arrival and initiation of care in unit, expected duration of surgery, arrival in and exit from OR time, time of meeting hospital discharge criteria (HDC),of surgical postoperative instructions and hospital discharge. For statistical analysis, Student-t test, Mann-Whitney test or chi-2 were used when appropriate. p<.05 was considered significant.
Results and Discussion: Salient results are : Lenght of stay(LOS)(min) 335[288-408] in CC vs 261[230-305] in SC (p <.001), delay between exit of OR and HDC(min) 22[15-54] vs 13[9-27] (p=.01), number of patients receiving surgical instruction s before HDC(%)
14(23) vs 30(100) (p<.001), waiting time for surgeon after HDC(min) 30[0-70] vs 0[0-0]
(p<.001) and exit delay after HDC(min) 75[51-120] vs 55[30-72] (p=.03)
No difference was found for ASA score, delay for care in unit, duration of surgery and time between arrival in hospital and OR.
Conclusion(s):Introduction of SC reduces LOS in ambulatory hand surgery under axillary blockade.An important factor allowing reduction of LOS is reduced delay for receiving postoperative surgical instructions.

05 / A specific clinical pathway improves efficiency of ambulatory surgical centers