Use of the substitution index to identify improvement opportunities in major ambulatory surgery

Abstract Major ambulatory surgery (MAS) is an alternative to traditional hospitalization. Its goals are to reduce cost while increasing patient safety and satisfaction. The substitution index of MAS has been used to identify those surgical procedures, which present the largest impact in avoidable stays. There is a wide margin for improvement in relation to the performance of MAS. Five DRG's account for more than 50% of the avoidable stays. To promote MAS, it would be necessary to introduce changes in financing and incentive policies, include new procedures, review clinical guidelines and establish benchmarking strategies.