Brucker Cosima, Dimpfl Thomas, Scharl Anton
Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Nürnberg, Germany.
Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Gesundheit Nordhessen, Kassel, Germany.
Geburtshilfe Frauenheilkd. 2024 Oct 1;84(10):920-927. doi: 10.1055/a-2376-9748. eCollection 2024 Oct.
In many cases, outpatient surgical treatment of benign diseases of the uterus has advantages over inpatient care. This has been demonstrated by the healthcare situation in other countries. However, the prerequisite for the provision of outpatient services is that this does not lead to any impairment in the quality of care or of patient safety. The ultimate goal should not be to reduce costs but rather to maintain and, ideally, improve the quality of care. This requires that services are not just defined by the surgical procedure but also by the entire treatment chain, including, for example, psychosocial support, and are remunerated accordingly. It is particularly worrying that the final decision as to whether an outpatient operation is possible is not the responsibility of the operating unit, but of the "Medizinischer Dienst," with the corresponding options and threats of sanctions. This situation is unique internationally and requires a paradigm shift. Furthermore, structural prerequisites must be maintained which currently only exist inadequately in Germany. Since a substantial proportion of planned outpatient operations require immediate or secondary inpatient treatment, there must be a barrier-free transition between the outpatient and inpatient sectors. This will require the creation of networks between outpatient service providers and one or more hospitals that are equipped and competent to manage even complex complications. It is important to create structures that, with intensive involvement of the operating unit, include adequate preoperative evaluation and patient education as well as needs-oriented postoperative care at home. The current separation of sectors is a significant hinderance. Moreover, when expanding and promoting outpatient surgery, the aspect of training and further education of specialist staff must be taken into account, as well as cross-sectoral quality assurance. Based on a review of the international literature, this article presents 13 recommendations for adequate structures when providing outpatient services which should serve as a prerequisite for the greatest possible guarantee of patient safety.
在许多情况下，子宫良性疾病的门诊手术治疗比住院治疗更具优势。其他国家的医疗状况已证明了这一点。然而，提供门诊服务的前提是这不会导致护理质量或患者安全受到任何损害。最终目标不应是降低成本，而应是维持并理想地提高护理质量。这就要求服务不仅由手术程序来定义，还应由整个治疗链来定义，包括例如心理社会支持，并据此给予相应报酬。特别令人担忧的是，门诊手术是否可行的最终决定权不在手术科室，而在“医疗服务部门”，且有相应的选择和制裁威胁。这种情况在国际上是独一无二的，需要范式转变。此外，必须维持目前在德国尚不完善的结构前提条件。由于相当一部分计划中的门诊手术需要立即或二次住院治疗，门诊和住院部门之间必须有畅通无阻的过渡。这将需要在门诊服务提供者与一家或多家有能力处理甚至复杂并发症的医院之间建立网络。重要的是要建立这样的结构，即在手术科室的积极参与下，包括充分的术前评估和患者教育以及以需求为导向的术后家庭护理。目前各部门的分离是一个重大障碍。此外，在扩大和推广门诊手术时，必须考虑专科工作人员的培训和继续教育方面，以及跨部门的质量保证。基于对国际文献的综述，本文提出了13条关于提供门诊服务时适当结构的建议，这些建议应作为最大程度保障患者安全的前提条件。
