Ambulatory Corner By Katherine H. Dobie, MD I t is estimated that more than 70% of surgery today is performed in the outpatient setting, with a forecasted 16% growth in outpatient volumes and a 3% decline of inpatient discharges in the next ten years. When considered within the context of the current trend to enhance our value proposition across all of healthcare, this rapidly changing landscape requires that we carefully consider our role in the outpatient perioperative space. As we embrace and navigate the advent of perioperative medicine and enhanced recovery, we must remain committed to applying the principles of this practice in the ambulatory setting. Ambulatory surgery has seen tremendous advances in the last ten years, with an increase in medically complex patients undergoing more difficult procedures safely at free-standing Ambulatory Surgery Centers (ASCs). Interestingly, the success of this evolution has relied squarely on some of the basic tenets of perioperative care, the same concepts that we are now applying inside the walls of the hospital. Ambulatory perioperative care by definition is an enhanced recovery program, with a prescribed, multidisciplinary protocol designed to deliver a fixed patient disposition: to home, pain controlled, great experience, and back to their baseline as soon as possible. ASCs are less expensive, have higher patient experience ratings, less complications, and most patients return to at least some functionality day of surgery. While we as perioperative physicians will need to lead the care that enhances the aforementioned metrics inside the walls of the hospital, it will be essential that we also remain focused on the surgical outpatient, and recognize that our ability to continue to innovate in this space will add immensely to our value proposition. It’s exciting to consider what cases we will be doing at free-standing surgery centers with a plan to discharge to home on the day of surgery in ten years. Ambulatory physicians are the gatekeepers of ASCs, holding the future of perioperative innovation in free standing centers in our hands. n Look for our “Ambulatory Corner” in the next newsletter, where we will expand on the challenges and opportunities facing Ambulatory Physicians in the context of Enhanced Recovery! Tom Hopkins, MD Chair, ASER Newsletter Committee Lyla Hance, MPH Co-Chair, ASER Newsletter Committee ASER ALERT • VOLUME 2, ISSUE 1 • aserhq.org 13
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