Baldi R, Lazzarato M, Masiero A, Mandini A
Direzione Sanitaria Arcispedale S. Anna, USL 31 Ferrara.
Epidemiol Prev. 1992 Sep;14(52):39-43.
In this essay, the authors provide a definition for those medical care facilities representing a consolidated alternative to traditional hospitalization. These facilities can be basically ascribed to the following patterns: day case surgery; day-hospital activity; home-care. Day case surgery is a complex and, in most cases, interdisciplinary procedure; this type of activity necessitates a pre-hospitalization period and often also a "protected discharge" or even a home-care service. Some specific criteria regarding day surgery activity have been defined as follows: the main criteria have a clinical nature, but they interact with others belonging to a social and structural-organizational order. The Royal College of Surgeons of United Kingdom has officially recognized in 1985 this medical care typology as one of the constituents of surgical care, and has evaluated that at least 1/3 of the overall operations could be carried out as day care surgery. In the United States, besides hospital and ambulatory surgery activity, a new pattern known as "free-standing center" has been promoted; in 1993, 35% of the operations is expected to be carried out in day case surgery centers. As far as Italy is concerned, in 1988 only day-hospital practice has been adequately recognized as an alternative medical care facility to traditional hospitalization. The Emilia Romagna region, in order to increase day case surgery activity, has issued in 1991 a list of 53 DRGs, in which day bed units treatment was possible. Up to now, however, only a small part of these diseases is treated on a day case surgery basis.
在本文中，作者为那些作为传统住院替代方案的综合医疗设施给出了定义。这些设施基本可归为以下几种模式：日间手术；日间医院服务；居家护理。日间手术是一个复杂的过程，在大多数情况下是跨学科的；这类活动需要一个住院前期，通常还需要“保护性出院”甚至居家护理服务。关于日间手术活动的一些具体标准已被定义如下：主要标准具有临床性质，但它们与属于社会和结构组织层面的其他标准相互作用。英国皇家外科医学院于1985年正式认可这种医疗类型为外科护理的组成部分之一，并评估认为至少三分之一的整体手术可以作为日间护理手术进行。在美国，除了医院和门诊手术活动外，一种名为“独立中心”的新模式也得到了推广；1993年，预计35%的手术将在日间手术中心进行。就意大利而言，1988年只有日间医院服务被充分认可为传统住院的替代医疗设施。为了增加日间手术活动，艾米利亚 - 罗马涅大区于1991年发布了一份包含53个诊断相关分组（DRG）的清单，其中日间病床单元治疗是可行的。然而，到目前为止，这些疾病中只有一小部分是通过日间手术进行治疗的。
