Organizational aspects to optimize patient's ambulatory pathway

Successful ambulatory care implementation should combine both medical and organizational features. These two components are closely interrelated. Only optimal organization, part of a quality management program, will allow us to perform safe medical procedures and provide good patient satisfaction. This review is intended to update organizational concepts that could improve ambulatory surgery center efficiency.

Current organizational concepts are based on the implementation of a dedicated pathway that could be divided into sequential steps, wherein the concepts of flow time and throughput should be applied. Wasted times have to be evaluated and suppressed, so patients have to spend only the minimum required time at each step. A 'forward pathway' would allow maintaining unidirectional patients' flow to avoid any blockade and to build sequential surgical program planning. These processes are easier to implement in dedicated facilities, managed by a dedicated staff, after extensive patient preoperative information, and with the use of numeric information systems.

Organizational feature in ambulatory surgery center is a major determinant of patient flow, activity, resource utilization, safety, and patient satisfaction. Most of these basic principles may contribute to improve the quality of care that can also be of benefit to conventional surgical activity.