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Developing a High Quality Day Surgery Strategy

Dr Ian Jackson President International Association Ambulatory Surgery spoke at today’s Improving Quality in Day Surgery conference on developing a high quality day surgery strategy include: 

•    The day surgery management team
•     developing a day surgery strategy
•     measuring success

Abstract
Developing a High Quality Day Surgery Strategy

In the current financial climate day surgery is an essential part of the survival strategy of every Trust in England. Maximising day surgery activity and so minimising the surgery bed base and optimising potential income from Best Practice Tariff are the keystone to the financial viability of surgical services. This talk covers the following areas

•    The day surgery management team
•    Developing a day surgery strategy
•    Measuring success

The day surgery management team
Successful day surgery units have a management team made up of a Clinical Lead (often but not always an Anaesthetist), a Nurse Lead and a Manager. In some units the Nurse Lead combines the management role. This team needs to establish an effective Operational Group that not only covers all specialties involved but also good representations from groups essential to the effective running of the service e.g. physiotherapy, pharmacy. Consideration should also be given to including outside agencies such as Age Concern who can help with support following discharge.

Developing a day surgery strategy
There is no doubt that this has to be sponsored from the very top of the organisation. The CEO must be convinced that this is important for the Trust and so ensure that this is recognised at Trust and Executive Board level. This can be aided by the creation of a ‘Day Surgery Change Board’ which should be chaired by a senior executive. This is important as they will set the vision for these meetings and ensure that surgical managers and lead clinicians are aware that attendance and delivery of objectives are not ‘optional’. 
Discussion with Surgical Directorates should be based on available information on performance e.g. using the BADS Directory of Procedures. Agreement needs to be reached on what can 

•    Default to day surgery for agreed procedures
•    Default to 23hr stay for agreed procedures
•    Transfer of theatre lists to day surgery

Data to support these discussions can be obtained internally using the BADS Directory (or the Electronic Assessment Tool) or from national organisations such as CHKS or Dr Foster. Those involved in discussion should also be aware of Best Practice Tariffs and current performance for these key procedures.

Facilities
Availability of suitable theatres and day ward are crucial when trying to transfer activity and close beds – however in an environment pressured for space and finance then the fundamental area that is important is the ward area to support day surgery.

How to measure success
It is important to chart activity over time especially when monitoring transfer of procedures into the day surgery arena. Charting weekly numbers of 

•    Surgical elective patients admitted as inpatient 
•    Surgical elective patients with management intent of day case allows the management team to monitor the transfer of activity. However the fundamental measure will be the successful closure or transfer of surgical beds.

Dr Jackson's full presentation is available to download at the end of this page.

Dr Ian Jackson qualified from Aberdeen Medical School in 1981 and appointed as Consultant Anaesthetist in York in 1989. Helped start the first Acute Pain Service in the UK. In 1991 I became responsible for the development of Day Surgery in York and I spent several years as Clinical Director for Anaesthesia, ICU and Theatres. I led the redesign of short stay surgery in York creating a 6 theatre day unit that includes a 22 trolley overnight stay area. I am now the Trust Chief Clinical Information Officer and work full time as part of our IT Team.
Elected to the Council of the British Association of Day Surgery in 1994 and served as the Honorary Treasurer, Editor of the Journal and President. I introduced and ran the BADS website for several years.
I have been involved at the national level in several initiatives aimed at redesigning the NHS including the 18 weeks referral to treatment initiative and the Darzi Review in England. Since joining the General Assembly of the International Association for Ambulatory Surgery I have redeveloped the website (www.iaas-med.com) and helped establish our journal Ambulatory Surgery as a free access online resource (www.ambulatorysurgery.org). 
I am currently President of the IAAS. 

Future events of interest:

National PROMs Summit 2014
Wednesday 3 December 2014 
Hallam Conference Centre, London

Masterclass: Improving Operating Theatre Quality, Finance & Efficiency
Monday 19 January 2015 
Hallam Conference Centre, London

The National Quality Standard for Surgical Site Infection
Thursday 12 February 2015 
Hallam Conference Centre, London

Setting Up and Running Virtual Clinics
Monday 20 April 2015 
Hallam Conference Centre, London


Download: Dr Ian Jackson's full presentation

20 November 2014

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