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Day surgery was first described more than 100 years ago, but it’s only really in the last 20 or so years that it’s become a popular form of care. As day surgeries increase, there’s been a realization that it provides a high quality form of care for the patient but also conveys significant economic advantages for the institution, thereby being a win-win situation with benefits for all those involved.
Patients now expect not only minimally invasive procedures but minimally disruptive procedures. So they anticipate as little damage from that surgeon or physician as possible.
The patient enters the hospital and is directed to the day surgery unit where he books in at reception.
They want as little disruption to their day-to-day life as possible. So they want the best care. As less threat as possible to their health and well-being and at their own convenience. So part of patient selection must be making sure that we’ve got the right and most minimal procedure necessary to give the patient the expected gains they’re looking for.
The patient is seated at a reception until he is called to the first forward wait area. From here, he is taken into an interview room for standard BP checks, form filling and so forth, before being invited to get changed from his outdoor clothes into a gown, dressing gown and slippers. Since I started here four years ago, we have carried out [inaudible] day cases. We’ve had no readmissions during that point. We have [inaudible] patients and there is an extremely high satisfaction rate with having surgery carried out as day surgery. The patient now goes to second forward wait until his name is called.
After his identity is checked once more, an escort nurse accompanies the patient as he walks to the unaesthetic room. More complex procedures obviously warrant visits to a clinician to confirm diagnosis to complete diagnostics, further interventions and maybe pre-anaesthetic assessment.
And with a greater degree of certainty, we know that patient is going to turn up on the day of operation ready for the procedure. The patient lays down on the day surgery trolley. Monitoring equipment is applied as he settles himself comfortably with the help of the nursing staff.
The anesthesiologist arrives and talks to him about what’s going to happen before administering the appropriate anaesthetic drugs.
It’s interesting with the day surgery unit, I’ve talked about the quick slick turnover of patients and you might think with a rapid turnover of patients it is quite difficult to keep them as safe as they might be in a in a slower environment. But actually from a patient safety perspective and the fact that we walk them to the anaesthetic room they climb on to the operating trolley and they stay on that trolley throughout that procedure and throughout their recovery period until they’re fit enough to climb off it and get dressed, means that the patient isn’t moved at all while they’re asleep. There’s no manual handling for the patient. So the possibility of them having any injuries or anything is virtually eliminated because they’re on the trolleys throughout.
There are considerable benefits to the theatre staff from day surgery, particularly with a modern set up using operating trollies. By using a trolley, manual handling is greatly reduced indeed avoided. So it was much less time spent in moving patients around; a much less potential for injury to staff. It’s been estimated that in the UK at least up to 40 percent of sickness absence results from manual handling injuries and this can have enormous costs, somewhere in the region of 400 million pounds a year.
Once asleep the anaesthetic staff wheel the patient on the trolley into theatre. Theatre staff are waiting to put on any operating table attachments required for the procedure.
The conditions awaiting him there are no surprises, no hidden things not done. And we can proceed with efficient and effective use of what is a healthcare’s most precious resource. It’s theatre time.
The theatre procedure is then carried out.
After the procedure is complete, the patient is taken still on the trolley into first stage recovery.
They don’t have to stay in hospital overnight. So it’s less inconvenience for them. One of the main advantages is an infection control perspective because obviously if they’re discharged home afterwards instead of being kept in and much less likely to acquire healthcare acquired infection. The patient is wheeled into a second stage recovery. They go home to their natural surroundings so they’re going to be more relaxed. And if somebody is more relaxed you know their appetite is going to return better. They’re going to be less anxious. They’re going to get a better night sleep and potentially recover much quicker.
The patient is informed about what to expect in terms of how he feels. He takes as much time as he needs and waits until his chosen person arrives to collect him. There are multiple patient benefits for this but it is very economically viable to have people coming in and going home the same day as opposed to requiring inpatient stays. I think what the future will lie is for carrying out some more surgery just purely under localize anaesthetic and more and more procedures will be able to be carried out as day case surgery.
Whenever surgery is performed, safety is clearly paramount and I’m firmly convinced that day surgery represents a very safe form of care. We know that re-admission to hospital which is one index of perhaps sub quality care is not significantly increased by the performance of day surgery. Indeed there are many centres with very high day case percentages. You have extremely low readmission rates implying that they are getting it right the first time and the quality of care is really good. I believe day surgery represent better care and safer care.
In the unlikely event that there are complications and the patient requires an overnight stay, the unit is connected to the main hospital via glass link bridge providing secure easy access to a ward environment. But under normal circumstances the day case patient will be collected by friends or family to go home.