Perioperative nurses perform operative or other invasive work for patients. These nurses can choose between two types of operating room environments: the traditional hospital setting or an ambulatory surgery center (ASC).
Ambulatory surgery centers are health care facilities that provide outpatient procedures. This includes same-day surgical care, as well as diagnostic and preventative procedures. Although there is an obvious difference between ASCs and hospitals, there are a surprising number of similarities, too.
One of the greatest similarities is that the type of surgical procedures performed is the same in both. In fact, physicians developed ambulatory surgery centers as a better way of booking surgical procedures. Physicians experienced a variety of obstacles to surgical procedures in hospitals, such as:
- Hospital operating rooms often have limited availability.
- There are scheduling delays.
- Due to budgets and strict policies, it may be difficult to get new equipment.
Physicians were very involved with the creation of ASCs, and they continue to be involved. About 90 percent of all surgery centers are partly owned by physicians.
Over time, hospitals have recognized the value of surgery centers. In fact, many ASCs are jointly owned by local hospitals. Hospitals have ownership interest in 23 percent of all ASCs, and two percent are owned entirely by hospitals.
Types of Surgery That Take Place
Last year, there were 21, 626,850 surgical procedures within the United States, with 53.1% of these surgeries being performed in ASCs. The following procedures were among the most common ambulatory surgeries:4
- Lens and cataract procedures (99.9 % performed in ambulatory settings)
- Cholecystectomy/common duct exploration (55.1 % ASC)
- Excision of semilunar cartilage of knee (98.5 % ASC)
- Hernia repair (90.2 % ASC)
- Lumpectomy (96.5 % ASC)
- Decompression peripheral nerve (95.2 % ASC)
- Transurethral excision; drainage; or removal urinary obstruction (71.9 % ASC)
- Pacemaker/cardioverter (64.0 % ASC)
- Skin graft (67.0 % ASC)
- Hysterectomy (39.8 % ASC)
- Laminectomy/excision intervertebral disc (26.1 % ASC)
Overall, the following therapeutic areas have the most prevalent volume of surgeries that are performed in ASCs:5
Therapeutic Class % of all ASC Procedures
Pain Management 22%
Advantages of using Ambulatory Surgery Center
Typically, ASCs make pricing information available to their patients in advance of surgery. The industry is eager to make price transparency a reality, not only for Medicare beneficiaries, but for all patients. To offer maximum benefit to the consumer, these disclosures should outline the total price of the planned surgical procedure and the specific portion for which the patient would be responsible. This will empower health care consumers as they evaluate and compare costs for the same service amongst various health care providers.
The ASC health care delivery model enhances patient care by allowing physicians to:
- Focus exclusively on a small number of processes in a single setting, rather than having to rely on a hospital setting that has large-scale demands for space, resources and the attention of management
- Intensify quality control processes since ASCs are focused on a smaller space and a small number of operating rooms
- Allow patients the ability to bring concerns directly to the physician operator, who has direct knowledge about each patient’s case, rather than deal with hospital administrators, who almost never have detailed knowledge about individual patients or their experiences
Physician ownership also helps reduce frustrating wait-times for patients and allows for maximum specialization and patient–doctor interaction. Unlike large-scale institutions, ASCs:
- Provide responsive, non-bureaucratic environments tailored to each individual patient’s needs
- Exercise better control over scheduling, so virtually no procedures are delayed or rescheduled due to the kinds of institutional demands that often occur in hospitals such as unforeseen emergency room demands
- Allow physicians to personally guide innovative strategies for governance, leadership and most importantly, quality improvement
As a result, patients say they have a 92% satisfaction rate with both the care and service they receive from ASCs. Safe and high quality service, ease of scheduling, greater personal attention and lower costs are among the main reasons cited for the growing popularity of ASCs.6
The Role of the Nurse in the Ambulatory Surgical Setting
The same-day surgery nurse is a specialized ambulatory care nurse, defined as a nurse who provides episodic care to patients for 24 hours or less in many different settings. The same-day surgery nurse cares for patients before and after same-day surgery and some patients undergoing outpatient procedures. Ambulatory care and same-day surgery nurses use cost-effective ways to assist patients in promoting health, preventing disease, and managing chronic or acute health problems. The same-day surgery nurse also promotes self-management and assists family members or friends in caring for their loved ones.
The same-day surgery unit is used not only for surgical patients but also for many medical patients. Patients requiring many kinds of I.V. therapy and blood transfusions and those scheduled for radiographic interventional procedures are brought to the unit. Patients recovering from upper endoscopies and colonoscopies spend time here. Patients having pain control procedures such as epidural steroid injections or trigger point injections recover here. Some SDS units also care for pediatric patients having outpatient surgery. Patients may be admitted through this unit for all major elective surgery. The American Nurses Credentialing Center (ANCC), which is part of the American Nurses Association (ANA), has a specialty certification for Ambulatory Care Nursing. The credential awarded is Registered Nurse-Board Certified (RN-BC). This certification is renewable every 5 years. You may also choose to maintain relevant certifications and join national, state, and specialized nursing associations.7
Requirements to be a Nurse in the Ambulatory Surgery Center Setting
Because the same-day surgery unit has a rapid turnover of patients, every day is different. Nurses on this unit must have the ability to adapt to changing situations. They also need to have good assessment skills along with some case management knowledge when caring for short-term patients. The education required to work in a same-day surgery unit may include a telemetry course and basic life support, advanced cardiac life support (ACLS), and pediatric advanced life support (PALS). Ambulatory care certification may be required, but even if it’s not, having it will give you a better chance of landing a job at this unit. Inquire at your hospital’s same-day surgery staff development department to learn the qualifications for joining this team.8
1 Sadler, Don, “The Ins and Outs of Ambulatory Surgery Centers,” OR Today, February 29, 2016.
2Senagore, Anthony, “Ambulatory Surgery Centers,” Encyclopedia of Surgery, Thomson Gale, 2004.
3 2004 ASC Salary and Benefits Survey, Federated Ambulatory Surgery Association, 2004.
4 Weir, Lauren, “Surgeries in Hospital-Owned Outpatient Facilities, 2012,” HCUP, February 2015.
5 ASCA Analysis of CMS Claims Data, 2010
6 “Outpatient Pulse Report,” Press-Ganey Associates, 2008.
7,8 Voda, Sandra, “Nursing Career Directory,” Lippincott’s, January 2011, Volume 41 Number 1- Supplement 2011, page 24- 25.