Review of the Efficiency of Veterans Administration Surgery Services

A review of outpatient surgery and preadmission testing programs being used in the Veterans Administration (VA) hospital system disclosed that opportunities exist, through increased use of these programs, to eliminate the need to hospitalize some veterans and to reduce the length of hospitalization for others. A review of a random sample of 233 surgical procedures from a universe of 6,382 procedures performed at three hospitals during 1975 indicated that from 744 to 1,338 of the 6,382 procedures could have been performed on an outpatient basis, saving from 2,177 to 5,657 hospital days. Projecting the results of the sample to a preadmission testing program indicated that a range of 482 to 998 cases could have had preoperative workups on an outpatient basis, resulting in additional savings of hospital days. In response to the recommendations of a National Academy of Science study, the VA has stated that studies will be conducted to determine the medical feasibility of performing more outpatient surgical procedures and to reduce the length of stay for surgery patients. A systemwide policy for outpatient surgery and preadmission testing should be developed, based on the results of the VA studies, and the policy should be implemented in all general medical and surgical hospitals in the VA system.