[Medical malpractice in ambulatory surgery].

Due to the structural reform of the public health service on Jan. 1, 1993, totally new conditions are generated for the hospital and partially for the surgical practice to extend the outpatient surgery, especially to transfer stationary tasks to the ambulant area. Additionally, to the basic contract according to SGB V for ambulant surgery, a special agreement about procedures for quality control in ambulant surgery according to sec. 14 of the contract regarding sec. 115b par. 1 SGB V has been added since June 13, 1994. Minimal requirements of quality are demanded to achieve a high quality in the outpatient area and maintain the standards of the stationary surgery. However, any detail has to be prospectively and more intensively considered, discussed and documented since the patient will not be available for supervision or discussion before and after surgery. The preoperative setting has to be checked carefully to avoid a situation where an elective surgery has to be postponed due to other pathologic findings or a faulty organization. The principle of trust may be applied when findings from other physicians are adopted but the final liability has the physician undertaking the surgery. The information of the patient after surgery has to be adapted to the symptoms. Thus, the symptoms of any problem or complication after surgery have to be explained to the patient that he can act properly if such problems occur. Actually, the patient's information after surgery is very important: pain, bleeding, prophylaxis of thrombosis, immobilization, transport problems and the availability of the surgeon at any time as well as a regular attendance during the consulting hours have to be clarified and discussed to maintain the demanded expert status of the physician and the valid medical standards as well as to meet the legal requirements for liability.