Extending the range of day case surgery is a declared aim of the new coalition Government. There are significant benefits to both hospitals and patients, from reducing healthcare-acquired infection to shorter waiting times for operations, so what is preventing day surgery? What are the barriers that need to be addressed and how can patient selection be expanded? LOUISE FRAMPTON reports.
In 2004, the Modernisation Agency identified “10 high impact changes” that healthcare organisations could adopt to make significant, measurable improvements in the way they deliver care. The agency claimed that its first high impact change, “treating day surgery (rather than inpatient surgery) as the norm for elective surgery”, could release nearly half a million inpatient bed days each year.1 However, progress in the expansion of day case surgery has been somewhat slow across the NHS. The McKinsey report, for example, revealed that a wide range of specialties are failing to achieve the recommended rate for day case surgery and, for some specialties, the actual rate was found to be nearly half that of the recommended rate.2 Speaking at a meeting hosted by the Royal College of Surgeons and the British Association of Day Surgery, entitled: “Day surgery and enhanced recovery: where next?”, experts claimed that, if good systems were put in place, 85% of elective surgeries could be performed as day cases (with patients discharged on the same calendar day). Delegates learned that the UK lags behind other countries; there is wide variation in practice across the UK; and many patients are being excluded unnecessarily from the selection criteria for day case surgery. Opportunities to treat more patients and reduce waiting times, save money, and minimise hospital-acquired infections are currently being missed. This may be set to change, however, as maximising the range and coverage of day surgery has been identified as a priority in the Government’s White Paper.
What is preventing day surgery?
Roddy Nash, clinical chairman, the Circle Nottingham NHS Treatment Centre, examined the question: “What is preventing day surgery?” Roddy Nash explained that he works as a consultant surgeon in a dedicated day surgery unit at the Nottingham NHS Treatment Centre. Operated by Circle subsidiary Nations Healthcare, the centre handles over 12,000 patient visits per month – including over 2,000 day case surgical procedures. He commented that, as day cases could account for 85% of the elective workload in the health service, it may be argued that more time should be concentrated on day surgery, while there should be an increased focus on teaching and training in this setting. However, he raised the question: how many Trusts currently concentrate investment in facilities and staff on day case surgery? “For many consultants, it is not considered a priority. From my previous experiences, I found that if consultants had to make cancellations, it was usually made to their day case list,” he commented. Roddy Nash examined some of the barriers that must be addressed – including unwillingness among surgeons and anaesthetists to move away from the “comfort” of inpatient surgery. One possible concern is that patients will be discharged and suffer complications at home where they are less accessible. Systems need to be in place to address this, therefore.
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