Tecnologías sanitarias: evaluación de la unidad de CMA del Hospital Nuestra Señora del Prado (Talavera de la Reina, Toledo)

Resumen

Introducción

La evaluación de tecnología sanitaria es el proceso de análisis del valor y la contribución de cada tecnología sanitaria relativos a la mejora de la salud individual y colectiva, incluyendo su impacto económico y social. Los objetivos del estudio son evaluar el funcionamiento de la UCSI en la organización, asistencia sanitaria, aspectos sociales y económicos.

Material y método

Pacientes intervenidos durante 2000 y 2001 con cirugía mayor ambulatoria (CMA), obteniendo datos de la unidad de cirugía sin ingreso (UCSI), la unidad de documentación clínica y admisión (UDCA) y la unidad de gestión (contabilidad analítica).

Resultados

La mayor implicación de profesionales y los resultados obtenidos soslayan problemas iniciales. Un total de 1.930 pacientes en 2000 y 2.074 en 2001 fueron intervenidos, la mayoría de oftalmología (18,51 y 25,12%), traumatología (17,11 y 18,42%), cirugía general (17 y 17,79%) y urología (16,07 y 15,33%); ASA I (75%) y ASA II (20%). Menos del 2,5% presentó suspensiones; un 4%, ingresos no esperados; un 0,05%, reintervenciones, y un 0,1%, reingresos. A las 24 h presentaba dolor un 59% (leve, 87%) y buen estado general un 96,15%. A los 6 meses un 78% presentaba un estado general excelente; un 99%, satisfacción excelente con la UCSI; un 95% volvería a operarse por UCSI; un 98% la recomendaría; un 98,5% recibió información al alta correcta, y en un 98% se evitaban alteraciones familiares y laboralesestudios. La disminución media del coste de intervenciones mediante CMA, al día de ingreso, fue del 48,70%. La amigdalectomía (87,46%), el hallux valgus (84,25%) y el legrado (81,66%) presentaron mayor disminución, y la vasectomía con anestesia, la menor (9,91%).

Conclusiones

La UCSI, como nueva tecnología sanitaria, es segura, efectiva, útil, produce cambios organizativos asumibles y es eficiente (ahorro de costes y estancias).

Introduction

Health technology evaluation is the process of analyzing the relative value and contribution of each health technology to individual and collective health, including its social and economic impact. The objectives of this study were to evaluate how the outpatient surgery unit (OSU) works within our organization and health services delivery, as well as social and economic aspects.

Material and method

Patients undergoing major ambulatory surgery in 2000 and 2001 were studied. Data were gathered from the OSU, the clinical documentation and admissions unit, and the management unit (analytic accounting).

Results

Initial problems were overcome by the greater involvement of health professionals and the good results. A total of 1,930 patients were treated in 2000 and 2,074 were treated in 2001. Most of the procedures were performed in ophthalmology (18.51% and 25.12%), general surgery (17% and 17.79%), and urology (16.07% and 15.33%). Seventy-five percent of the patients were American Society of Anesthesiology (ASA) I and 20% were ASA II.There were less than 2.5% cancellations, 4% unexpected admissions, 0.05% repeat surgery, and 0.1% readmissions. After 24 hours, 59% of the patients reported pain (mild in 87%) and 96.15% reported general well being. After six months 78% reported excellent general well being. Ninety-nine percent reported satisfaction with the OSU to be excellent, 95% would repeat surgery in the OSU and 98% would recommend it. A total of 98.5% reported that they received accurate information at the time of discharge and 98% believed outpatient surgery avoids family and occupational/academic disruptions (98%).The mean cost saving in major ambulatory surgery was 48.70% compared with one-day admission. The greatest savings occurred in amygdalectomy (87.46%), hallux valgus (84.25%), and curettage (81.66%). Vasectomy with anesthetist showed the smallest saving (9.91%).

Conclusion

The OSU is a safe, effective and useful new health technology, involves reasonable organizational changes and is efficient (savings in costs and admissions).