[Structure and organization of ambulatory and day treatment in a university clinic]

Massive increases in costs of health care on one hand and the development of "minimal invasive" surgical techniques on the other hand have enforced an ambulatory or "day-care" treatment policy. Yet, the involvement of hospitals in ambulatory treatment has been limited in Germany, but in the near future this situation will change. In a small number of major hospitals, day surgery programs are going to be established even for infants or for patients at risk for prolonged postoperative monitoring or hospitalization. For these patients the concept of "same day surgery" is suitable. It includes ambulatory anesthesia and operation with the possibility of hospital stay, if necessary. The actual concept at the Justus-Liebig-University Giessen is described. This (at least in Germany) new approach to ambulatory operative treatment decreases costs of health care, improves the chances of hospitals in competition with private practitioners and last not least improves the status of the ambulatory compared with the hospitalized patient.