Outpatient surgery: IGAS points the brakes to its development

France is lagging behind in outpatient surgery. One in two operations should be performed in a day hospital by 2018, according to the last report of the General Inspectorate of Social Affairs (Igas) and the General Inspectorate of Finance (IGF). Health Minister Marisol Touraine was a little too optimistic last April, announcing that the goal would be reached in 2016.

Size savings

The government has posted an ambitious goal: to boost outpatient surgery. The private sector did not wait for the Minister of Health: in half of the cases, patients go home on the day of the operation. The public sector is lagging behind with only 30% of day hospitalizations. “The trend of progression is not sufficient to achieve the objective of a majority outpatient practice by 2016”, slices the Igas.

In terms of savings, on the other hand, the Igas agrees with Marisol Touraine. The minister announced a reduction in spending of 500 million euros in 2016. The report expects an equivalent range (417 to 689 million), carried out on three different positions: night and weekend staff, productivity, and territorial reorganization.

Heavy obstacles

In its analysis, the Igas highlights many obstacles to the wider use of ambulatory care. The reorganization of the hospital is a major obstacle, since it requires rethinking the premises and training the teams. “The requirement of outpatient surgery is primarily organizational in nature: care within 12 hours requires a new organization, centered on the patient”, specify the authors of the report.

Furthermore, not all patients are eligible for outpatient treatment. The social or geographic isolation of an individual constitutes a contraindication to this type of care. His state of health may also require overnight hospitalization.

The Igas report also puts its finger on a more difficult problem to solve, that of the training of surgeons and anesthetists. “The observation of insufficient mastery by surgeons or anesthesiologists of the required surgical and anesthetic techniques must lead to the establishment by the establishment of appropriate actions to improve practices”, underline its authors.

Real benefits

In establishments with extensive use of outpatient hospitalization, the benefits are not slow to be observed. So much so that the Igas evokes the “untapped potential” of France, which is far behind compared to Europe. The various assessments carried out by the Haute Autorité de Santé (HAS) and the Anap (the National Agency for Support to the Performance of Health and Medico-Social Establishments) report the many advantages of this type of care. In addition to reducing waiting times, day hospitalization reduces the risk of nosocomial infections. It also requires recourse to less invasive surgical techniques, which improves the postoperative comfort of the patient.

Making the patient a stakeholder in their health generally improves the quality of care. Better informed and more involved in the care, he is logically more satisfied. The authors of the report also point out “greater proximity to nursing staff during their short stay in the care center, which decreases anxiety and improves the comfort of patients, including the elderly. It remains to overcome the general stagnation of the public sector.