Outpatient Vs Inpatient Circumcisions

[kthelan2]

I'm a Labor and Delivery/Mother-Baby Nurse at a Level 2 hospital. We currently perform circumcisions on an inpatient basis, but I want to spearhead that we start doing them outpatient. Does anyone work at a hospital where the circumcisions are done outpatient? My argument is that reimbursement is very low, especially since it takes up many resources to actually perform the circumcision as well as deal with any complications that arise afterwards. My only concern is with different types of insurance and the process of making it a seamless process. I would love any and all feedback for either side!

[klone, MSN, RN]

I am opposed to any type of initiative that would encourage or facilitate circumcision.

[ashleyisawesome, BSN, RN]

I am not a fan of circs to begin with, but if they are going to be done, I would prefer it be done inpatient. When it's done in the hospital, the nurses can monitor for complications. If they are going to do it in an office they should keep the baby for observation for an hour or two at least to make sure everything is alright. I mean, it is technically a surgery. If it's done in an office and the kid goes home and starts hemorrhaging, can't pee or shows signs of infection, the parents might not know what to do (even if given instructions). If the kid starts bleeding in the hospital, we have resources like pressure dressings and epi and the knowledge to recognize when it's normal post procedure bleeding vs too much. Plus when it's done in the hospital, we have the opportunity to demonstrate a proper diaper change and how to care for a circ'd member right in front of the parents, then coach them through it the next time he has a dirty diaper. You might not get that chance if it's done in an office and the parents take him home right away with nothing but some paper printouts telling them how to care for it. Some people learn better by observation and doing and might ignore or forget verbal/written instruction.

[LibraSunCNM, BSN, MSN, CNM]

IDoes anyone work at a hospital where the circumcisions are done outpatient? My argument is that reimbursement is very low, especially since it takes up many resources to actually perform the circumcision as well as deal with any complications that arise afterwards.

No, all of our circs are done inpatient. I don't know of any outpatient settings in this area that do circs, although I've heard of it happening elsewhere in the country. Even if a baby isn't cleared to be circ'd by peds while inpatient after birth, say due to a hypospadias or something, if it gets fixed and the parents want a circ, that will be done with pediatric GUs in the OR.

You feel that it takes up "many resources?" I can't say I agree. A circ tray, a staff member to be with the baby while the provider does the circ, some lidocaine, some gauze, some Bacitracin, that's pretty much it. It takes about 15 minutes total. Reimbursement is definitely low, I agree on that. I wouldn't circ my kid in a million years, but I don't think the process itself is one that needs to be moved to the outpatient setting for any particular reason.

[BittyBabyGrower, MSN, RN]

We have one doc that does them

outpatient. Sometimes our little preemies go home before they get circ' due to not even a 1.1 fitting! I'm not sure how long they keep them after its done, but our protocol is 2 checks 30 minutes apart and they have to pee.