^/Health Planning ^iic ngjifH library
Bibliography Series
Planning for Outpatient
Surgery Services:
An Annotated Bibliography
PAM BIND
RA
410
.7	,
A12H4
no. 13
PUBL.
CAT/ANALS
U.S. DEPOSITORYPUBLIC HEALTH LIBRARY
HEALTH PLANNING SERIES
The Bureau of Health Planning is a primary resource for current
information on a wide variety of topics related to health planning.
To facilitate the dissemination of this information to health planners,
the Bureau issues publications in the following series:
Health Planning Methods and Technology
This series focuses on the technical and
administrative aspects of health planning.
Included are such areas as methods and
approaches to the various aspects of the
health planning process, techniques for
analyzing health planning information
and problems, and approaches to the effective
dissemination and utilization of technical
information.
Health Planning Information
This series presents information on the
analysis of issues and problems relating to
health planning including trend data, data
analysis, and sources of data to support
health planning activities.
Health Planning Bibliography
Bibliographies on specific health planning
subjects are published in this series. Subject
areas are selected by the frequency of inquiries
on specific topics and from suggestions by
Bureau staff and health planners throughout the
nation.
"Planning for Outpatient Surgery Services:	An Annotated
Bibliography" is thirteenth in the Health Planning Bibliography
Series.Planning for
Outpatient
Surgery Services:
An Annotated
Bibliography
March 1 979
HRP 0301301
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Health Resources Administration
Bureau of Health Planning
National Health Planning Information Center
DHEW Publication No. (HRA) 79-14005
For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402PREFACE
This bibliography was developed in recognition of the need to keep
health planners informed of trends in the provision of health
services, particularly trends in methods of providing health
services which may reduce the costs of health care. The development
and use of outpatient surgery services has been found to be
instrumental in controlling the escalating costs of providing
and obtaining health care.
Included in this bibliography are citations and abstracts of
documents describing the organization and use of the broad range
of outpatient surgery facilities and services. While the intended
audience is health planners, this document should prove useful
to all concerned with the provision of health services, including
health providers, consumers, professional organizations, and State
and local officials responsible for the development of comprehensive
health service systems.
iii
104029INTRODUCTION
Of particular importance to health planners and health care providers
alike is the need to control the escalating cost of providing and
obtaining health care. In recent years it has been determined that
many surgical procedures that have traditionally involved several
days of hospitalization can be performed on an outpatient basis.
It has also been determined that reduction in the amount of inpatient
care required creates an immediate cost savings which benefits both
the consumer and the provider. The consumer is spared the expense
of several days hospitalization, including the cost of the room and
the attendant routine inpatient care. The development of outpatient
surgery facilities frees hospital beds for more seriously ill patients,
and allows the hospital to shift its personnel and financial resources
to improving or expanding other services. Consequently, there is
currently an increasing interest in the concept of outpatient surgery
services, also referred to as surgi-centers, ambulatory surgery,
and day surgery.
In order for outpatient surgery to provide the greatest benefit to
the many groups involved—consumers, providers, and third-party payers—
it must be planned for as an integral part of the health care delivery
system. This bibliography was developed in response to the need for
information on the organization and use of outpatient surgery service
facilities.
While in no way an exhaustive study, this bibliography should serve
as a basic reference to currently available literature on outpatient
surgery. It includes citations and, if available, abstracts of documents
identified from literature searches of the data bases of the National
Health Planning Information Center and the National Library of Medicine
(MEDLINE). The references selected for this bibliography have been
published in the United States since January 1973 and are organized alpha-
betically by the author. To aid the user, a personal author index
follows the citations.
The Center will continue to acquisition related citations on the
topic and update the bibliography periodically. Suggested references
or donations of documents should be submitted to:
National Health Planning Information Center
Center Building, Room 5-22
3700 East-West Highway
Hyattsville, Maryland 20782
ivAlvear, D.T. , Metzger, P.P.
Pediatric Outpatient Surgery in a Community Hospital.
Pa Med 79(3):52-3, March 76-
Bale, C.
Is 'In And Out* Surgery Beady To Stay Put?
Group Practice 26(3):10-2,14,16 passim May-June 77.
Barton, M.D.
Outpatient Surgery and Anesthesia.
Primary Care 4 (1): 183-97 March 77.
Beaton-Mamak Mary
Case for Ambulatory Surgery -
Pub. in Dimensions in Health Service p42-44 Aug 74.
Day surgery or ambulatory surgery in Canadian hospitals is
surveyed. The concept of day surgery involves providing
minor surgery and discharging the patient the same day- It
frees beds for inpatient care, medical costs are reduced by
the time factor, and patient care is maintained at a high
level. Preoperative and postoperative care is described for
the Winnipeg Health Sciences Centre, Central Newfoundland
Hospital, and the Hospital for Sick Children in Toronto. The
Children's Pavilion of the Winnipeg Centre conducts almost 40
percent of its surgical load on a not-for-admission basis.
In 1973, 3,344 day surgery procedures were performed at the
Hospital for Sick Children. The facilities at McMaster
University Medical Centre in Hamilton and the Greater Niagara
General Hospital are underused. Canadians have not been
guick to understand the advantages of the hospital day
surgery facility. The future of day surgery in Canada
depends heavily on whether or not rapid discharge means
anything to the patient and whether lower operating costs
mean anything to the hospital.
Bell Audrey
Children's Medical Center, Dallas, Tex-
Day Surgery:	A Concept of Care for the Pediatric Patient.
Pub. in Association of Operating Room Nurses Jnl. v19 n3
P623-631 Mar 74.
Pediatric patient care in a day surgery unit at Children's
Medical Center of Dallas is discussed. Children's Medical
Center is a general acute care pediatric hospital as well as
a teaching institution. The ambulatory surgery load per day
at the center is 12 to 18 patients per day. The day surgery
unit is designed for the low-risk health child with
uncomplicated emergency or problems wnich require no extended
1inpatient observation following recovery from anesthesia.
The program is based on the premise that tte patient will be
able to go home after surgery and, therefore, there are no
beds in the day surgery unit. The decision to utilize day
surgery is made by the physician and the patient's parents-
It is noted that the program's success is dependent, to a
significant extent, on the attitudes and capabilities of
nurses xn the day surgery unit. Routine procedures followed
for a typical surgical patient are traced. The hospital cost
for patients utilizing the day surgery service is reduced
since tnere is no room charge. A $25 administration charge
is incurred for day surgery patxents, but this charge is
negligible in comparison to rates for hospital rooms which
ranged from $46 to $70 per day in 1974. Charges for
laboratory services, radiology, pharmacy, surgery,
anesthesia, and recovery room are the same in the day surgery
unit as for an inpatient. For the child, the greatest
advantage of the day surgery program is that he can remain in
his own familiar surroundings prior to and following surgery.
Brand Ronald
Health Services Management, Inc., Indianapolis, Ind.
Ambulatory Outpatient Surgery (Draft Report),
52p 10 Oct 73 Available NTIS PB-249 129/8
The purpose of this report is to provide background
information for the Central Indiana CHP (CICHP) Council
against which a proposal for an ambulatory surgical center
could be appraised. The concept of ambulatory outpatient
surgery is discussed and compared with other types of
surgical services. The advantages and disadvantages of
different approaches to ambulatory outpatient surgery are
also discussed. The authors identify key questions to be
considered by a community reviewing existing or proposed
ambulatory outpatient surgery services. A general model and
related information are given to assist in answering these
guestions for a proposed free-standing ambulatory outpatient
surgery center in Marion County, Indiana. (NTIS)
Calnan James
Royal Postgraduate Medical School, London (England).
One-Day Surgery for Rheumatoid Arthritis.
Pub. in Nursing Mirror v143 n5 p51-53 29 Jul 76.
The provision of outpatient surgery services for rheumatoid
arthritis and other patients in a self-contained minor
surgery unit attached to Hammersmith Hospital in Great
Britain is described. The unit, located in a converted hut
near the main entrance of the building, is run by four
part-time nurses and a part-time worker. The nurses work
with approximately 60 physicians who perform varicose vein.
2urology, breast biopsy, orthopedic, medical rheumatology,
general surgery, plastic surgery, procedures in the unit's
operating room — all on an outpatient basis- The costs of
converting the hut and maintaining and operating the unit are
summarized- Patient care procedures and administration are
described. Advantages of the outpatient system are pointed
out. In 6 years, the minor surgery unit treated an average
of 1,200 patients a year. Hand operations accounted for just
over 100 patients annually, and an itemized list is included
of the different procedures performed. Plans for expanding
the outpatient surgical service for rheumatoid arthritis to
include foot as well as hand procedures are noted- It is
observed that the unit's experience has shown that outpatient
surgery is not second-class therapy, but may offer a better
service to suitable patients. Photographs of the unit's
operating theater, recovery room, waiting room, kitchen, and
exterior are included.
Comprehensive Health Planning Council of South Florida, Inc.,
Miami.
Goals, Criteria and Guidelines for Ambulatory Surgical
Services in Dade County.
23p 1974 Available NTIS HEP-0004910
Criteria and guidelines for ambulatory surgical facilities in
Dade County are presented by the Comprehensive Health
Planning Council of South Florida to support the primary goal
of providing high-guality services to meet the ambulatory
surgery needs of Dade County residents- Criteria for
ambulatory surgical services include availability, high
guality, accessibility / guantity, affordability, efficiency,
acceptability, effectiveness, and comprehensiveness-
organizational guidelines are proposed for licensure,
accreditation, transfer agreements, authority / ownership,
chief executive, medical staff, medical review committees,
and staff meetings. Guidelines are also proposed for
facility usage, location of surgery, surgical procedures,
charges and reimbursement, staff, equipment, and physical
plant. Health personnel and procedural guidelines are
included. Portions of this document are not fully legible.
Comprehensive Health Planning Council of South Florida, Inc.,
Miami.
Background Document on Ambulatory Surgical Centers.
48p Oct 74 Available NTIS HEP-0004909
A background paper on ambulatory surgical centers (ASC) in
Dade County, Florida is presented to enable the Comprehensive
Health Planning Council of South Florida to plan for the
integration of a technological innovation into the existing
health delivery system. Ambulatory surgery and ambulatory
3surgical facilities are defined and an historical overview is
provided- A Florida Hospital Research and Education
Foundation study found that the specific procedure to be
performed in the ambulatory center is of less importance than
the length and complexity of the operation, the patient's
general age and condition, and duration and type of
anesthetic. The advantages of ASCs include personal
attention to the patient, personal attention to the
physician, less psychological trauma, faster scheduling, pre
- operative and postoperative support by the family,
reduction of time away from home, reduction in hospital costs
and bed use, and reduction of cross infections. Issues to be
considered in determining the type and location of an ASC are
costs to patients and community, impact on quality of care,
access to care, and comprehensiveness of care. The
ambulatory surgical centers in Dade County are described in
terms of resources, services, capacity, and utilization. The
appendix contains a list of procedures and charge schedules
from several Dade County ASCs.
Crockett Pernell W
National Technical Information Service, Springfield, Va.
Control of Health Care Costs (A Bibliography with Abstracts).
63p Apr 78 Available NTIS NTIS/PS-78/0317/4
Citations are presented on studies of various strategies for
cost containment in hospitals, long term care facilities, and
ambulatory care. Some topics covered are the effectiveness
of: Shared services and facilities; design and space planning
of hospitals; closing of underutilized and substandard
facilities; incentives for employee productivity;
improvements in personnel staffing; prospective and incentive
reimbursement by third-party payers; alternative delivery
systems, such as health maintenance organizations and
ambulatory surgicenters; utilization and rate review; and the
roles of State and National Government in regulating Medicaid
and Medicare expenditures. (Contains 58 abstracts)
Davis James E
Watts Hospital, Durham, N.C. Dept, of Surgery.
Day Surgery:	A Viable Alternative-
Pub. in the Association of Operating Room Nurses v19 n3 Mar
74.
Day surgery is discussed as a viable alternative to
hospitalization. Surgery without overnight hospital stay is
known as ambulatory surgery, short-stay surgery, in-and-out
surgery, outpatient surgery, day surgery, and drive-in
surgery in various parts of the U.S. This type of surgery
can be defined as surgery of an uncomplicated nature which
customarily has been done on an inpatient basis but which can
4be done equally as effectively on an outpatient basis. It is
noted that most one-day surgical cases are of a
gynecological, otolaryngological, or general surgical nature.
Three different physical arrangements for one-day surgery are
in use:	(1) special wards for admission, preoperative
evaluation, and postoperative care; (2) rooms for
preoperative and postoperative care and (3) autonomous units
which have their own operating room as well as space for
preoperative and postoperative care. The use of one-day
surgery at Watts Hospital in Durham, North Carolina is
discussed in terms of the impact of such surgery on operating
rooms, nursing and administrative staff, anesthesia staff,
and surgical and surgical resident staff. It is concluded
that one-day surgery is safe and economical as an alternative
to hospitalization and that the impact of such surgery is to
increase markedly the workload of operating rooms, recovery
rooms, and departments of anesthesia.
Erbstoeszer Marie
Washington Univ., Seattle. Dept, of Health Services.
Ambulatory Surgery Criteria and Standards Monograph,
207p Dec 75 Available NTIS HKP-0015430/2
The purpose of the monograph is to provide local and state
health planners with the basic information they need to
develop criteria and standards for planning and reviewing
ambulatory surgery services. The monograph summarizes and
analyzes both the technical factors and the policy issues
which planners need to consider. While the major focus of
the monograph is the presentation of suggested criteria and
standards, background information and reference material is
also provided in the Introduction and Appendix Sections.
(NTIS)
Ford John L
Ford Surgical Centers, Phoenix, Ariz.
Outpatient Surgery — Present Status and Future Projections.
Pub. in Southern Medical Jnl. v71 n3 p311-315 Mar 78.
The state of the art of outpatient surgery is examined, with
particular attention given to the experience of a Phoenix,
Ariz. , facility. The discussion opens with a review of
outpatient anesthesia. It is noted that about 90 percent of
all surgery in outpatient surgical facilities is being
performed under general anesthesia. In the past, attempts to
perform minor surgery on an outpatient basis were frustrated
in part by a lack of a good general anesthetic. Some
specific agents used (e.g.. Sodium thiopental) are discussed.
Other concerns touched on include intubation (a procedure
supported in the article), the types of operations most
frequently performed on an outpatient basis, and the
5potential of outpatient surgery for lowering costs. It is
observed that 35 to 40 percent of all the surgery performed
in the United States could be performed in ambulatory
surgical facilities. The transfer of previously inpatient
procedures to outpatient facilities results in savings both
in hospital costs and time (e.g., surgeon time spent
traveling to the hospital, patient time spent in the hospital
and away from work). Other areas considered are the
construction and design of an efficient facility; nursing
care (nursing morale, staffing requirements) ; patient
records; and rules set up between health regulatory agencies
and the insurance industry (e.g., that there will be no
overnight beds at the Phoenix facility). It is concluded
that the goals set up for the Phoenix facility — reducing
surgical care costs, broadening insurance coverage, and
making the outpatient a first-class citizen in health care —
have been met.
Goran Michael J, Donaldson Magruder C
Bureau of Quality Assurance, Rockville, Md.
Ambulatory Surgery Standards Needed-.
Pub. in Hospital Progress v57 n8 p47-51,55 Aug 76.
The reduction of health care costs through ambulatory surgery
is addressed, and the need for ambulatory surgery standards
is emphasized. It is estimated that inpatient surgery
accounts for 60 percent of all hospital expenditures and 25
percent of total health care expenditures. It is felt that
ambulatory surgery may be a feasible way of reducing the
direct costs of health care services while maintaining or
improving the quality of care. Two major cost issues in the
performance of ambulatory surgery are noted:	(1) the added
financial burden to hospitals in communities where the demand
for hospital beds is low; and (2) the effect of the
availability of ambulatory surgery facilities on demand for
procedures. The role of local health planning agencies in
meeting community needs and balancing the impact of
ambulatory surgery facilities is discussed. The potential of
ambulatory surgery for improving tne quality of care is
explored. The need for structural, process, and outcome
standards is noted. Structural standards concern basic
physical characteristics of a facility. Process standards
relate to the manner in which ambulatory facilities function.
Outcome standards are the basis for general criteria of
success in achieving goals. The importance of professional
standards review organizations (PSRO's) and cooperation among
all parties involved in ambulatory surgery is examined.
Particular attention is given to the application of standards
and to accountability and measures of quality assurance.
6Goran, M.J., Donaldson, M.C.
Ambulatory Surgery Standards Needed.
Hosp Prog 57 (8) :47-51,55, August 76.
Green Morris
Indiana Univ., Indianapolis. Dept, of Pediatrics.
Innovative Methods of Expanding Ambulatory Services.
Pub. in Advances in Pediatrics v20 p15-38 1973.
Innovations in the delivery of ambulatory care are discussed,
with emphasis on primary health care, hospital outpatient
services, and community ambulatory services. Acceptable
standards of primary health care, it is noted, emphasize
prevention in a broad sense. The question of the ability of
the hospital, as opposed to the community-based facility, to
delivery primary health care services is noted. Among
hospital-based approaches to ambulatory care are the
following:	emergency room services; pediatric diagnostic and
therapeutic services; continuity of care groups; traveling
clinics; day hospital programs; ambulatory surgery;
short-stay units as an alternative to inpatient admission;
home care programs based in hospitals; observation nursery
schools, allowing observation of young children with
developmental problems by a number of specialists; child life
services for hospitalized children; adolescent centers;
physician service and parent service representatives in
pediatric hospitals; parent education centers; and parental
care pavilions, which are motel-like facilities in which the
child's mother provides nontechnical nursing services for the
child while learning about the child's health problems and
their management. Among community-based alternatives to
hospital ambulatory arrangements are children and youth
projects, neighborhood health centers, and neighborhood
multipurpose human service centers. References are included.
Hamilton, P.
Reluctance Evident in Slow Growth of Same-Day Surgery.
Employ Benefit Plan Rev 30 (8):40-1, February 76.
Hannon Francis Joseph.
Duke Univ., Durham, N.C. Graduate Program in Hospital
Administration.
Ambulatory Surgery Unit — Its Cost Feasibility, with
Specific Reference to Rex Hospital, Raleigh, North Carolina-
69p Apr 73 Available from University Microfilms
International, 300 N. Zeeb Road, Ann Arbor, MI 48106.
The economic feasibility of the operation of an ambulatory
surgery unit by Rex Hospital in Raleigh, N.C., is
investigated. Four distinct approaches used by various
7hospitals in the provision of ambulatory surgical services
are examined. It is shown that ambulatory surgical systems
do increase the utilization of existing facilities and
provide service to a greater number of patients and that the
impact of such systems on bed utilization and required
inpatient beds to serve a general population can be
significant in health care planning. Data on the utilization
of outpatient facilities at Rex Hospital are given.
Outpatient surgery is concentrated in one subspecialty due to
the number of procedures performed by a plastic surgeon and
is limited by the hours available in the general operating
suite-i Based on a 3-month survey, it was estimated that the
hospital could expect an 8 percent increase in demand for
operating time for ambulatory surgical cases in 1973, with
the total exceeding 1,000 procedures. Ambulatory surgical
costs in 1972 were $63,743, and the average cost per patient
was $70. The loss from operating the ambulatory surgical
system to handle outpatients in the emergency room, operating
suite, and recovery room was $49,038. Alternatives to the
provision of ambulatory surgical services are discussed- It
is recommended that Rex Hospital implement a segregated
ambulatory surgical unit to serve more patients and reduce
actual costs per patient- Appendixes contain additional
information on the utilization of ambulatory surgical
services, and a bibliography is provided.
Holton Felicia A
What Future Now for Surgical Centers.
Pub. in PRISM v3 p46-48, 50-53 Mar 75.
Surgicenter is an independently owned, short stay, ambulatory
surgical unit offering patient care at a cost below that
charged for similar procedures when they are done at a
hospital.. In addition surgeons enjoy the same autonomy they
do in private practice. First opened in Phoenix, Arizona, in
1970, the center averages 30 surgical procedures daily, and
an equal number of diagnostic and therapeutic blocks are
performed daily in the pain clinic. Patients are charged a
flat fee regardless of tie amount of blood used or hours of
nursing time involved. The average bill is about $120. The
average length of stay for patients is three and a half
hours, and the procedure most frequently performed is a
diagnostic D and C, followed by laparoscopy with tubal
coagulation. Abortion cases are not accepted by the center-
The center has had an impact on the cost of ambulatory
surgical care in Phoenix and on the way such care is
delivered- Administrators are being forced to take a look at
the high cost of their inpatient ambulatory surgery.
8Hughes, W.F.
An Ambulatory Surgical Service by Norwalk Hospital Department
of Surgery.
Conn Med 40 (9): 592-6, Sept 76.
ICF, Inc. Washington, D-C.
Selected Use of Competition by Health Systems Agencies.
221p Dec 76 Available NTIS HRP-0023513
This study was conducted to determine if there are
circumstances under which health planners might want to
encourage selected forms of competition among health care
providers as a means of reducing costs or improving quality
and accessibility. Opportunities for the use of market
incentives in health planning were explored in relation to
health maintenance organizations (HMO's); ambulatory surgery
facilities (ASF's); and the disclosure of price, quality, and
other information about health services to improve the
ability of consumers to select providers who can meet their
health and financial needs. The impact of HMO development
and growth on community health care costs was analyzed.
Based upon the analysis of HMO competition, recommendations
on health planning policies for the review of HMO's seeking
certificate-of-need or Federal funds approval were made and
policies for determining tue need for HMO's in health systems
plans were suggested! Health planning policies for ASF*s
were examined, although less data were available for them
than for HMO's. Opportunities for the use of information
disclosure to improve the operation of local health care
markets were examined. Particular attention was given to how
health planners can sponsor experiments to evaluate the
potential benefits of such disclosure. References are
provided at the end of each chapter in the monograph.
In and Out Surgery-
Pub. in Perspective p1-14 1974.
The growth of outpatient surgery in the United States is
traced, characteristics of outpatient surgery programs are
discussed and illustrated in examples, and the perspectives
of professional associations, insurance carriers, hospitals,
physicians, and government agencies- A survey conducted by
the American Hospital Association in 1972 found that more
than 23 percent of the Association's member hospitals
provided outpatient surgery, but that only 45 hospitals had
free-standing outpatient surgery facilities- The question of
who should be in charge of ambulatory surgery centers
(physicians or hospitals) is raised. It is noted that the
spectrum of procedures being conducted on an outpatient basis
is surprisingly wide and includes procedures that some say
are inappropriate for outpatient surgery. It is pointed out
9that hospitals face a number of problems in deciding whether
to establish an outpatient surgical facility- The cost of
the surgical procedure remains the same regardless of where
it is performed, and only the overhead (the institutional
component) changes with the introduction of outpatient
surgery- The major consideration is that, if minor surgery
moves outside the hospital, the hospital loses income that
offsets other fixed costs. Statements reflecting the
viewpoints of professional organizations, hospital
administrators. Blue Cross plans, physicians, and the Federal
Government concerning ambulatory surgery are presented.
Standards used by one Blue Cross plan in judging whether a
hospital-based or physician-owned surgical center gualifies
for reimbursement are summarized.
Independent Centers Reduce OP Surgery Cost-
Employ Benefit Plan Rev. 29 (11) :26,28, May 75.
Jones Clyde W
Naval Regional Medical Center, San Diego, Calif. Dept- of
Anesthesiology.
Anesthesia for Outpatient Surgery.
Pub. in the Jnl. of the National Medical Association v66 n5
p411-415 Sep 74.
Outpatient surgery is discussed as a solution to rising costs
of medical care and as a means of making more efficient use
of existing surgical facilities. Considerations in the
organization of an outpatient surgical service are discussed.
It is noted that anesthetic considerations are fundamental to
this service even though surgical considerations largely
determine the types of procedures suited to outpatient
management. Safety guidelines in the administration of
outpatient anesthesia are presented. Patient management is
discussed in relation to preoperative evaluation,
intraoperative procedures, anesthetic technigues, and
postoperative evaluation. Outpatient surgical services at
the Naval Regional Medical Center in San Diego, California
are detailed*. In a two-year period from 1972 to 1974, over
6,000 outpatients were treated at the center and
approximately 1,375 procedures were performed. Problems
associated with and benefits of an outpatient surgical
facility are discussed. It is concluded that the judicious
use of regional anesthetic technigues in the management of
injuries not in themselves requiring hospital admission
represents a significant advance in anesthetic care. It is
also concluded that reduced costs of medical care and
increased efficiency in the utilization of existing surgical
facilities are significant pressures for the continued
development of outpatient surgical facilities.
10Korttila, K.
Minor Outpatient Anaesthesia and Driving.
Mod Probl Pharmacopsychiatry 11:91-8, 1976.
Lane, D.D., Mazzola, G.
Ihe Community Hospital As A Focus for Health Planning.
Am J Public Health 66(5) :465-8# May 76.
Lieberman Samuel L, Giacoia Esther B, Fedak Michael
State Univ. of New York at Buffalo. School of Medicine.
Hospital-Based Outpatient Surgery:	Anesthesia Experiences.
Pub. in New York State Jnl. of Medicine v75 n3 p437-441
Feb 75.
Ihe use of anesthesia in surgery, on an outpatient basis, for
minor procedures is recommended, based on experience of the
outpatient department at the DeGraff Memorial Hospital in
North Tonawanda, New York. Reasons for promoting the use of
outpatient surgery are noted. Only light - plane general
anesthesia is recommended, but it is suggested that
outpatient anesthesia facilities be contained within a
hospital and not in a free-standing facility where standby
facilities are available. In a series of 40,000 cases
treated at DeGraff Memorial Hospital over a 28-year period,
no death or serious complication occurred. Patients must be
carefully surveyed and screened before outpatient anesthesia
procedures, including laboratory studies. Types of
medications used in the program at DeGraff are discussed,
along with minor problems that were observed in some cases.
Tables present surgical procedures, number of cases between
1968-1972, and average postoperative length of stay in
hospital.
Luft, H.S.
Benefit-Cost Analysis and Public Policy Implementation: From
Normative to Positive Analysis.
Public Policy 24 (4):437-62, Fall 76.
Mandel Mark D, Spivack Saul
Boston Univ., Mass. Center for Health Planning.
Directory of Standards and Criteria for Project Review —
National Review of the State of the Art. Connecticut
Certificate of Need Compliance Workbook Series — Report 6-
148p 4 Oct 77 Available NTIS HRP-0900064
This report is one in a series prepared by the Boston
University Center for Health Planning in Massachusetts to
assist the State of Connecticut in revising its certificate-
of-need program. It is specifically intended for use by the
11Connecticut Commission on Hospitals and Health Care, the
Connecticut Bureau of Health Planning and Development, and
the five Health systems agencies in the State. The state of
the art in quantitative standards and criteria for a selected
sample of health services is discussed. A national search
for quantified standards and criteria was conducted by
examining documents from the following sources:	State health
planning and development agencies, State regulatory agencies,
regional health planning agencies (comprehensive health
planning agencies and health systems agencies). Federal
regulatory agencies, medical societies, professional groups
and associations, special-purpose standard task forces,
contract and grant research projects, and technical journals.
The arrangement of the succeeding directory of standards and
criteria for health services is hierarchical:	standard
subject area, scope of consideration, standard type,
standard, and criteria. For each health service, the
standards cover service availability and accessibility,
capacity considerations, resource utilization, demand
estimation and projection, resource need projection, and
financing. Health services included in the directory are
ambulatory care, ambulatory surgery, burn care centers,
computerized axial tomography, home health services,
inpatient psychiatric facilities, institution-based clinical
laboratory services, institutional long-term care, and renal
dialysis facilities and end-stage renal disease programs.
Mason Elizabeth S
North Carolina Dept, of Human Besources, Baleigh. Div. of
Facility Services.
Outpatient Surgical Facilities. A Suggested Planning Guide.
33p 30 May 75 Available NTIS HBP-0003867
A planning guide for outpatient surgery facilities is
presented by the Division of Facility Services of the North
Carolina Department of Human Besources. Examples of surgical
procedures which could be performed on an outpatient basis
are listedi Steps to be taken in determining the feasibility
of an outpatient surgical program are described, including:
literature review; determination of current activities in
other communities; determination of community needs; and
estimation of costs. Operational program development is
discussed. General elements of operation to consider in
planning are defined as follows:	selection of patients;
diagnostic and evaluation procedures; patient admissions,
surgical preparation, recovery, and discharge; staffing of
medical and nursing personnel; and administrative functrons.
A schematic illustration depicts the functional elements of
the outpatient surgery process for cases utilizing general
anesthesia or local anesthesia with sedation. General
elements of design and equipment for outpatient surgical
facilities are outlined. A six-page bibliography and a list
12of organizations which can assist in planning outpatient
surgical facilities are included.
Miseveth Paul A
Mount Carmel Mercy Hospital and Medical Center, Detroit, Mich.
Marketing Ambulatory Care.
Pub. in Hospital Progress v59 n3 p53-61 Mar 78.
Marketing or economic changes that can be made in the
delivery of ambulatory care by hospitals are examined. While
ambulatory care systems are not impacted by P. L. 93-641, the
potential for restrictions is imminent. It is certain that
the degree of regulation over the hospital environment will
continue to grow. Because of increased health insurance
coverage in ambulatory and preventive care services and
because of the desire of consumers to keep the loss of
leisure time to a minimum, many consumers are seeking
alternatives to hospitalization to meet their health care
needs. These alternatives include health maintenance
organizations, primary care clinics, and ambulatory surgery.
The health care industry is competitive, and a first step in
the marketing of ambulatory care involves product research
and development. A "grass roots" survey should be taken to
determine the specific needs of a community. Local planning
agencies, social service agencies, and church groups can be a
vital source of information. One source of consumer market
information is a listing of calls received by hospitals daily
reguesting names of physicians. The design of a
comprehensive ambulatory care program is detailed in relation
to five basic categories of ambulatory services:	emergency
services, diagnostic services, outpatient clinic services,
ambulatory surgery, and special outpatient services. The
substitution of clinic for emergency room care is discussed.
Norman Jacgue B, Schoonhagen Kenneth J, Hamilton James E,
Bailey Orpha M, Finley Beth C
Norman (Jacgue) Associates, Inc., Greenville, S.C.
Basic Criteria and Standards for the Establishment and
Operation of Selected Medical Services in South Carolina.
94p 30 Jun 74 Available NTIS HRP-0004389
Guidelines for the establishment and operation of eight newly
developed medical services are outlined in this report
prepared for the South Carolina Department of Health and and
Environmental Control. The eight services covered include:
the Neonatal Intensive Care Unit; Linear Accelerators used in
radiation therapy; Surgicenters, also known as in-and-out,
day, or ambulatory surgery:	Drug Detoxification and Therapy
Center; Cardiac Catheterization Laboratory; Ambulatory Care;
Stress Laboratory; and Cardiovascular Surgical Unit. A
search of the literature was conducted, and hospitals were
13inventoried; those which indicated in response to a
Questionnaire that the} offered one or more of the above
services were further contacted for data needed to establish
the guidelines. Need and justification for the establishment
of each service is determined by size of population needed to
economically support the service; and by general
considerations for construction, eguipment, personnel, and
supportive services and talent; these considerations are
specified for each service. A separate chapter is devoted to
each service and a bibliography closes each chapter. The
appendix contains the Questionnaire and cover letter sent to
each South Carolina hospital. A study of the incidence of
alcoholic patients admitted to Arcadia Memorial Hospital with
tables listing primary and secondary diagnoses is also
included.
O'Donovan Thomas E
Dynamics of Ambulatory Surgery.
Pub. in Hospital Administration v50	p27-39	1975.
The trend toward one-day, outpatient surgery for minor
procedures is assessed, and its impact on traditional
inpatient hospital surgery is discussed. Advocates of
outpatient surgery state that it can free hospital beds for
seriously ill patients and reduce surgical waiting time for
elective surgery. New technigues in anesthesia and in
control of bleeding have paved the way for physician and
patient acceptance of outpatient surgery- Pediatric surgery
is cited as eminently suitable for short-stay surgery, which
is said to reduce the psychological trauma of hospitalization
for children. In addition, potential benefits of outpatient
surgery include reductions in health care costs and
maintenance of Quality. The controversy between advocates of
inhospital and independent surgical center short-stay
procedures is discussed, and extension of insurance coverage
to each kind of facility is considered- Other factors to be
considered in establishing independent facilities include:
whether the new facility duplicates existing hospital
facilities; under what controls or regulations the facility
operates; and whether care is provided only for those who can
pay or for indigent patients as well. It is concluded that
competition offered by independent facilities, to the extent
that it improves Quality and access to care without costly
duplications of personnel and facilities, is desirable.
14O'Donovan Thomas E
Mount Carmel Mercy Hospital and Medical Center, Detroit, Mich-
Ambulatory Surgical Centers:	Development and Management.
250p 1976 Available from Aspen Systems Corporation, 20010
Century Boulevard, Germantown, Md. 20767-
Steps in the creation or expansion of a formal program of
ambulatory surgery in both hospital units and independently
operated facilities are discussed. Broad issues affecting
the quality and performance of ambulatory surgery are
examined. Several case studies are analyzed to show detailed
approaches taken by health care facilities in establishing
and maintaining viable programs of ambulatory surgery- Some
of the issues discussed include wnether additional surgery
facilities are needed to satisfy the caseload, whether
hospitals and independently operated facilities should create
or expand ambulatory surgical facilities, who should perform
the creation or expansion of facilities, how such facilities
can be established (staffing and organization), role of the
surgeon versus the role of the anesthesiologist,
reimbursement, what surgery is most amenable to ambulatory
treatment, whether centers should be organized on a profit or
nonprofit basis, how to obtain a certificate of need, and how
a Hospital should institute a formal program of ambulatory
surgery* It is felt that ambulatory surgical centers are
appropriate for any size hospital, and the bed capacity of
hospitals in the case studies cited ranges from 170 to 559
beds. Four program categories are outlined for ambulatory
surgery program consideration:	(1) master plan of ambulatory
surgery; (2) hospital programs of ambulatory surgery; (3)
independently operated ambulatory surgical centers; and (4)
broad issues in ambulatory surgery- Additional information
is appended on procedures and costs involved in the
performance of ambulatory surgery. A bibliography is
provided.
O'Donovan, T.E.
Ambulatory Surgery.
E Soc Health J 96(3):129-3, Jun 76.
Ogg, T.W.
Day-Case Surgery:	Problems Eelated to fiecovery.
Proc E Soc Med 68(7):414-5, July 75.
Outpatient Surgery:	Present Status and Future Projections.
South Med J 71(3):311-5, March 78.
15Phalen, J. re-
planning A Hospital-Based Outpatient Surgery Program.
Hosp Prog 57(6) :64-5,70, June 76.
Reed, W-A-, Ford, J-L.
Development of an Independent Outpatient Surgical Center.
Int Anesthesiol Clin 14(2):113-30, Summer 76.
Rosoff, C-B-
The Potential for Outpatient Surgery-
Int Anesthesiol Clin 14(2) :1-8, Summer 76.
Ruckley C- V, Ludgate C. M, Maclean Mary, Espley A- J
Major Outpatient Surgery.
Pub- in the lancet v2 n7839 p1193-1196	26 Nov 73.
Outpatient management of major surgical operations at the
Western General Hospital in Edinburgh, Scotland is described.
Once outpatient management has been determined, the patient
receives a thorough medical assessment at the hospital, and a
district nursing sister visits the patient's home to discuss
arrangements and check on the suitability of the home
environment. On the day of surgery, the patient arrives at
the hospital, the operation is performed, and if there are no
complications, the patient is discharged home by ambulance
and visited by the district nursing sister. The nursing
sister continues her home visits for several days. Patients
are reviewed in the outpatient department two to three weeks
after surgery* Of the 300 patients treated from 1969 to
1973, 155 had operations for varicose veins and 93 for
hernias- Ten percent of the patients had complications such
as delayed wound healing, chest infection, and jaundice- In
19 cases, discharge was delayed beyond the afternoon of the
operation, but ten of these patients were discharged later
the same day. If patients are carefully selected for
outpatient surgery, this method is feasible, safe, and
efficient, saving both space and manpower-
smith, A. M.
Why You May Need An Ambulatory Surgical Center.
Hosp Top 55 (3) :28,30,33-34, May-June 77-
16Stehling Linda C, Zauder Howard L
Texas Univ. Health Science Center at San Antonio.
Outpatient Surgery.
Pub. in Texas Medicine v70 p61-64 Aug 74.
The outpatient program instituted in July 1971 at Bexar
County (Texas) Hospital is described as one example of a
successful surgical program for ambulant patients. This and
other outpatient, or day surgery, programs have three primary
aims:	to deliver surgical care that is less expensive but
comparable in guality to that delivered to inpatients; to
prevent hospital - acquired infection; and to maintain the
integrity of the family unit. Factors essential to the
success of these programs, such as careful selection of
patients, indoctrination of surgeons in selecting appropriate
procedures, and completion of pre-surgery procedures, are
discussed. In two years, 2,800 patients have been treated on
an outpatient basis at the Bexar County facility; of these
1,087 were gynecological patients- There was an estimated
aggregate saving to the patients, third party carriers, and
county taxpayers of $278,400 for the 2,784 of these patients
who did not require admission (based on cost of hospital
hotel accommodations for two days at $50 per day,). There was
also a potential savings of $98,560 brought about by
preventing the accumulation of 985 inpatient days required by
acquisition of nosocomial infection by 8 percent of these
patients. In addition, that 8 percent of patients would have
required $22,400 worth of antibiotics, bringing the total
savings to $399,360, or $142.63 per patient. A graph of
caseloads, list of instructions given to patients undergoing
outpatient general anesthesia, list of outpatient surgery
procedures, and statistics on procedures performed, age of
patients receiving general anesthesia, anesthetic agents
used, duration of recovery room stay, and numbers of patients
requiring admission are included- A proliferation of such
in-hospital and free-standing outpatient surgery centers is
predicted. A bibliography is included.
Superior California Comprehensive Health Planning Association,
Chico.
Services Planning Guidelines-
139p Jul 75 Available NTIS HfiP-0017298
The Superior California Comprehensive Health Planning
Association (SC/CHPS) services and facilities advisory
committee and staff developed service planning guidelines for
the 12-county area using a grass roots process in addition to
traditional research methods. The grass roots process
included meetings with professional and technical people,
consumers and providers on comprehensive health planning
councils, and specialized local agencies and organizations.
The committee was charged with determining the minimum
17population base needed to economically and efficiently
support each health care service, examining existing planning
guidelines with respect to their applicability to a
predominantly rural area, providing a basis for services
needs determination and implementation, and providing a basis
for performing mandated reviews on applications for services
and facilities.. Planning guidelines are presented for the
following services:	obstetric, pediatric, intensive care,
hospital outpatient, emergency, heart, home health,
ambulatory surgery, radiation therapy, burn care,
developmental disability, psychiatric, end-stage kidney,
rehabilitation, and health maintenance organizations. A
description of service requirements, access to services,
economic and financial criteria, utilization, and population
information is presented for each service- A bibliography
and a list of organizations contacted are appended.
TransCentury Corp., Washington, D.C.
Ambulatory Surgery: Current Practices and Policy Issues.
196p 7 Mar 75 Available NTIS PB-258 185/8
The purpose of the project was to provide a general resource
base for the conference that was to be held on ambulatory
surgical services. The study, in effect, was a
state-of-the-knowledge study on ambulatory surgery which
identified some of the major issues in need of further
research. The report moved toward a comprehensive definition
of ambulatory surgical facilities and provided detailed
information on selected characteristics of facilities that
were currently in place. The report analyzed and described
these characteristics related to the staff size and
composition, patient characteristics, hours of operation,
procedures performed, utilization of facilities, billing
practices, financial information, referral sources, and
followup procedures. The report also included an annotated
bibliography on ambulatory surgery and a methodology for
conducting a study, along with an inventory of data sources.
(NTIS)
18PERSONAL AUTHOR INDEX
Alvear, D.T.......................................................... 1
Bale, C.............................................................. 1
Bailey, Orpha M....................................................  13
Beaton-Mamak, Mary .................................................. 1
Bell, Audrey ........................................................ 1
Brand, Ronald ....................................................... 2
Calnan, James ....................................................... 2
Crockett, Pernell W.................................................. 4
David, James E....................................................... 4
Donaldson, Magruder C................................................ 6,7
Erbstoeszer, Marie .................................................. 5
Epsley, C.J......................................................... 16
Fedak, Michael ..................................................... 11
Finley, Beth C...................................................... 13
Ford, John L......................................................... 5
Ford, J.L........................................................... 16
Gracoia, Esther B................................................... 11
Goran, Michael J..................................................... 6,7
Green, Morris ....................................................... 7
Hamilton, James E................................................... 13
Hamilton, P.......................................................... 7
Hannon, Francis Joseph.............................................   7
Hiller, James A..................................................... 16
Holton, Felicia A.................................................... 8
Hughes, W.F.......................................................... 9
Jones, Clyde W...................................................... 10
Kortlila, K.......................................................   11
Lane, D.D........................................................... 11
Lieberman, Samuel L................................................. 11
Ludgate, C.M........................................................ 16
Luft, H.S........................................................... 11
MacLean, Mary ...................................................... 16
Mandel, Mark D...................................................... 11
Mason, Elizabeth ................................................... 12
Mazzola, G.......................................................... 11
Metzger, P.P......................................................... 1
Miseveth, Paul A.................................................... 13
Norman, Jacque B.................................................... 13
O'Donovan, Thomas R................................................. 14,15
Ogg, T.W............................................................ 15
Patterson, Elizabeth M.............................................. 16
Phalen, J.F......................................................... 16
Reed, W.A........................................................... 16
Rosoff, C.B......................................................... 16
Ruckley, C.V........................................................ 16
Saltzstein, Edward C................................................ 16
19Schoonhagen, Kenneth J...........................................   13
Smith, A.M......................................................... 16
Splvack, Saul ...................................................   11
Stehllng, Linda C.................................................. 17
Sullivan, Charles B................................................ 16
Zauder, Howard L.................................................   17
* U. S. GOVERNMENT PRINTING OFFICE :	1979—625-997/1492
20Redd in Public Health LiDrary
JAN 2 8 198bbhp m
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Health Resources Administration
Bureau of Health Planning
Division of Regulatory Activities
DHEW Publication No. (HRA) 79-14005