The implementation of the week surgery in an orthopedic and urology ward and assessment of its impact

The implementation of the week surgery in an orthopedic and urology ward and the assessment of its impact.The week surgery (WS) is one of the models organized according the intensity of care that allows the improvement of the appropriateness of the hospital admissions.To describe the implementation and the impact of the WS on costs and levels of care.The WS was gradually implemented in an orthopedic and urology ward. The planning of the surgeries was modified, the wards where patients would have been transferred during the week-end where identified, the nurses were supported by expert nurses to learn new skills and clinical pathways were implemented. The periods January-June 2012 and 2013 were compared identifying a set of indicators according to the health technology assessment method.The nurses were able to take vacations according to schedule; the cost of outsourcing services were reduced (-4.953 Euros) as well as those of consumables. The nursing care could be guaranteed employing less (-5) full-time nurses; the global clinical performance of the ward did not vary. Unfortunately several urology patients could not be discharged during the week-ends.A good planning of the surgeries according to the patients' length of staying, together with interventions to increase the staff-skill mix, and the clinical pathways allowed an effective and efficient implementation of the WS model without jeopardizing patients' safety.