Background: With ageing populations and increasing rates of chronic diseases leading to a growing demand for healthcare, outpatient care is increasingly seen as a promising alternative to inpatient care. Outpatient surgery has increasingly moved out of hospitals and ambulatory surgery centres and into physician’s offices internationally in recent decades. However, significant concerns about patient safety in this setting have been raised internationally. Despite these concerns, there remains a general lack of regulation and oversight in this setting internationally. In Switzerland, while there have been efforts to improve surgery safety in the inpatient setting, there are concerns that the same efforts are not being undertaken in the outpatient setting, particularly given the apparent diffusion of surgical care in this setting and the current lack of regulation. However, we are not aware of any previous research concerning patient safety in office-based surgery in Switzerland.
Aims: It is currently unclear what the key issues are in relation to patient safety in office-based surgery in Switzerland and what the next steps need to be. This research therefore aims to 1) identify the key issues and concerns regarding patient safety in office-based surgery in Switzerland, and 2) develop a conceptual framework for a larger project on patient safety in office-based surgery in Switzerland, including the key questions that need to be answered and the research designs and methodologies that are needed to address these questions.
Design: The Delphi method is a widely used and accepted method for gathering data from respondents within their domain of expertise. It is an iterative process which collects and condenses the judgments of experts using a series of data collection and analysis techniques, combined with feedback. The method is well suited when there is incomplete knowledge about a problem or phenomenon.
Methods: Expert sampling: Experts who are considered to be knowledgeable about the subject and capable of representing the views of his or her peers will be recruited. Purposive sampling will be used to achieve sample diversity according to predetermined factors. Experts will be divided into two “subgroups”: 1) Experts in surgery and anaesthesia, and 2) Experts in quality and regulation. In accordance with recommendations regarding the Delphi method, we will aim to have around 10-18 experts in each group. Step One: Identify key issues and concerns regarding patient safety in office-based surgery in Switzerland. Experts will be interviewed individually and asked to respond to open-ended questions. All interviews will be audio recorded and transcribed verbatim and analysed using conventional content analysis. Step Two: Develop a conceptual framework for a larger project on patient safety in office-based surgery in Switzerland, based on the responses of the experts in step one. This will include the key questions that need to be answered, and the research designs and methodologies that are needed to address these questions. Step Three: Receive written feedback from the experts on the conceptual framework developed in step two. Necessary modifications to the framework will be made in light the feedback received. If required, this step will be repeated until consensus among the experts is reached.
Relevance of the project: This research is highly relevant for physicians, cost-effective health care planning, and patients themselves. With surgery increasingly moving into the outpatient setting, it is important to identify potential safety concerns and possible procedures that may assist safe and cost-effective care in this setting, but which do not cause undue practical or legal burdens.