• Jean Marty and Emmanuel Samain.
• aAnesthesia, Intensive Care and Emergency Medicine, University Paris-Est Créteil School of Medicine, Créteil, France bDepartment of Anesthesiology and Intensive Care Medicine, University of Franche-Comte cSchool of Medicine, University Hospital of Besancon, Franche-Comte University, Besancon, France.
• Curr Opin Anaesthesiol. 2017 Apr 1; 30 (2): 230-235.

Purpose Of ReviewEnsuring the quality and safety of anaesthesia in the face of budgetary restrictions and changing demographics is challenging. In France, the environment is regulated by the legislation, and it is often necessary to find solutions that seize opportunities to break with the traditional organization.Recent FindingsPostoperative mortality remains excessively high. The move towards ambulatory care is being adequately integrated into all the stages of patient management in the context of a single therapeutic plan that is mutually agreed upon by all caregivers. The French National Health Authority, which provides certification for healthcare establishments, encourages this 'seamless' approach between private practice and the hospital setting, based on teamwork and interdisciplinary consultation. By daring to break with traditional organizational structures, and by taking account of human factors and staged strategies, it is possible to deliver appropriate care, with a level of quality and safety that meets users' demands.SummaryThe management of a patient undergoing surgery with anaesthesia is a seamless spectrum from the patient's home to the hospital and back to home. Decision-making must be multidisciplinary. Increased use of ambulatory care, breaks with traditional organizational structures, and efforts to reduce postoperative mortality represents opportunities to improve overall system performance. Demographic and economic constraints are potential threats to be identified.

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