The day surgery pathway & patient selection
Dr Kim Russon, President, The British Association of Day Surgery (BADS)
I am a Consultant Anaesthetist and Clinical Lead for Day Surgery at The Rotherham Foundation Trust. I am privileged to have a fantastic Day Surgery team who are committed to delivering a high quality Day Surgery service. Regular reviews of our day surgery criteria and service has resulted in the number of patients through our DSU rising from 4000 patients in 2007 when I started, to over 6000 last year. I also have an interest in Regional Anaesthesia (RA) and Education. I regularly teach on national RA courses and the RA MSC run by University of East Anglia. I am co-editor for the RA section of Anaesthesia Tutorial of the Week. I have written RA articles, chapters in books and an E-Learning module. I was on the Society for Education in Anaesthesia’s council for 8 years (Secretary 2012-2015). I am the current President-elect for the British Association of Day Surgery (BADS) and I organising the BADS Annual Conference in London on 27/28th June 2019.
Dr Russon said: "What about emergencies? There is no reason for them not to be a successful day case. Are patients fit for surgery, is there anything we can do to optimise this? When considering exclusions, you do need to be more generous on the day case selection… If you are not, what are the reason? Think about developing new pathways, who do you need to speak to? You need people who are enthusiastic about it."
General Principles of Day Case, Emergency General Surgery
Professor Doug McWhinnie, Consultant Vascular and General Surgeon, Milton Keynes Hospital NHS Foundation Trust
Elective surgery, over the years, has significantly reduced its surgical bed numbers, but with pressure now on emergency surgery to do likewise, how can this be achieved?
By applying day surgery principles to the emergency pathway, many minor and intermediate emergency procedures may now be discharged on the day of operation. But we can go further and reduce the number of emergency admissions not requiring an intervention by allocating a senior decision-maker to the admissions pathway. Many emergency patients can now be managed on an out-patient basis, returning to hospital on a daily basis for review, investigations or results through the use of ‘Hot Clinics’. Many requiring a minor procedure can wait at home in the ‘Virtual Ward’ to await admission when an operating theatre slot becomes available.
Adopting surgical same-day emergency care is no longer an option, but an essential pathway to maximise scarce resources for those patients who really do need to be admitted to an emergency bed.
"It’s easy to complain there’s not enough money, but it’s more complex than that. If you look at the increase in admissions, it could well be an increase in population, a decrease in social care and an decrease in primary care. More elective day surgery has prompted a reduction in beds, which in turn has prompted more increase in elective day surgery… If there are no beds, you have to go home! You’ve got to get rid of a lot of beds and convert them into trolleys and trolley spaces." Professor Doug McWhinnie
Principles of Same Day Ambulatory care – the 10-year plan
Mr Arin Saha, Consultant Upper GI and Bariatric Surgeon, Huddersfield Royal Infirmary
Over the past decade, there have been progressive and persistent challenges to the delivery of a safe, high-quality and sustainable emergency surgical service. The greater volume of patients, the reduction in bed numbers and the difficulties encountered in primary care mean that more and more referrals are requiring assessment and treatment by the surgeons. A key component of a sustainable service is a high-functioning Surgical Ambulatory Emergency Care unit and this has been recognised as a vital part of the NHS 10 Year Plan which aims to establish surgical Same Day Emergency Care (SDEC) units across the country. Arin Saha will discuss challenges and opportunities involved in setting up surgical SDEC units and describe the important steps that should be followed when establishing such models of care.
GIRFT- Get It Right First Time
Dr Chris Snowden, Consultant Anaesthetist, Newcastle upon Tyne Hospitals NHS Foundation Trust, Joint Clinical Lead for Perioperative Medicine, Royal College of Anaesthetists
Getting It Right First Time (GIRFT) is a national programme designed to improve medical care within the NHS. GIRFT works on the principle that a patient should expect to receive equally timely and effective investigations, treatment and outcomes wherever care is delivered, irrespective of who delivers that care. Unwarranted variation in care related to overuse of ineffective treatments and underuse of effective treatments are often based on clinician preference in the absence of best practice knowledge. GIRFT aims to identify pragmatic best practice approaches from across the NHS that improve outcomes and patient experience, without the need for radical change or additional investment. It then seeks to create effective sharing of these experiences across clinical practice. The current presentation will look at current variation in pathways of care that exists across the UK based surgical spectrum and will investigate the areas of perioperative medicine that may be important to effect change in day case pathways for the future.
"This is about pathways and this is about patient care… we have to stop thinking about just what happens in the recovery area, we have to think beyond that to going home after surgery… into the right environment"