News and Updates from today's Breast Surgery as Day Surgery conference
Following opening introductions, Dr Anna Lipp Consultant Anaesthetist Norfolk and Norwich Hospital & Past President The British Association of Day Surgery, opens the conference with a session focusing on 'The Day Surgery Pathway', covering:
• Referral pathways
• Patient suitability
• What happens on the day of surgery
In her presentation Dr Lipp stated:
"Pre operative assessment, face to face with a nurse lasts 45 minutes, the discussion of discharge to home is very important"
"Pre operative assessment need clear guidelines to determine suitability. 2011 AAGBI ones are widely adopted"
"Very important to have good immediate anesthetist assessment"
"BADS – We are a victim of our own success as more and more patients are suitable for Day Surgery"
"If possible try to get patients into a dedicated day surgery unit"
"Be clear about what the criteria for discharge are. If in surgical notes then very useful for nurses"
"Nurse Led Discharge is not just appropriate for Day Surgery, appropriate for any length of stay"
"Very important to have private transport home after surgery, with a carer, not a taxi"
Dr Lipp's biography:
Immediate past-President of British Association day surgery, previously chair of publications and council member since 2005. Consultant anaesthetist Norfolk and Norwich University Hospital, lead for day surgery and pre-operative assessment with particular interest in peri-operative management diabetes. Honorary lecturer UEA School of medicine and health sciences. A varied medical career has encompassed training in anaesthetics in UK and Zimbabwe, working in Pakistan managing an immunisation programme for Afghan refugees and bringing up my family.
Mary Stocker Consultant Anaesthetist South Devon Healthcare NHS Foundation Trust President The British Association of Day Surgery, continues the morning by looking at 'Evaluating Performance in Day Surgery', covering:
• Measuring quality in day surgery
• Evaluating the pathway
• Measuring outcomes
In her presentation Mary stated:
"The Ultimate outcome is patient satisfaction"
"Patient selection, are you too conservative, challenge yourself"
"Would the management of a patient be any different if he/she were admitted as an inpatient"
"We gone from very strict patient selection to no limits from 1990 to 2016"
"It's important to monitor unplanned admissions, do monthly analysis"
"We had unplanned admissions going up so asked nurses to check patients and see if anything happened overnight that could not have been done at home? This leads in an increase with nurse confidence to discharge"
"It's very important to know symptoms after discharge, we phone all of our patients"
"We need to treat Day Surgery as the norm"
"www.productivity.nhs.uk is a very good website but unfortunately under threat, we are working with them though"
"No doubt that dedicated day surgery facilities improve efficiency"
"Day surgery unit, we can no longer be the poor relation, need the better kit"
Mary's presentation abstract:
As day surgery increasingly becomes the normal provision for all elective surgery, monitoring the quality of services provided becomes increasingly important, in terms of not only surgical outcomes but also patient experience measures and economic value.
In this session, we will look at the standards that should be strived for by all units providing day surgery services. We will examine the range of procedures which should be offered on a day surgery basis and the steps which can be put in place in order to enable them to be so. Increased day surgery activity must be accompanied by high quality patient outcomes in terms of low unplanned admission rates, post-operative symptoms and requirement for intervention from other clinical services. We will examine the factors which are required to ensure these outcomes are delivered and the requirement of good information technology to continuously monitor and improve them.
Mary read chemistry at Oxford University, including research into novel approaches towards drug design, subsequently she worked as a research chemist in the pharmaceutical industry. In 1990 she turned her hand to medicine, qualifying from Bristol University, her anaesthetic training was undertaken in the South West with a year at the University of Virginia, USA. She now works in Torbay as a Consultant Anaesthetist. Since 2004 she has been Director of Day Surgery for South Devon Healthcare Trust, one of the national leading trusts for day surgery in terms of innovation, day case rates and the quality of patient outcomes. She has developed training modules in day surgery for medical students and anaesthetic trainees and a training course for nurses undertaking day surgery preoperative assessment. She worked with the Royal College of Anaesthetists to produce an e-learning package in pharmacology. She has published widely in the day surgery literature and authored a number of book chapters on the subject.
Mary has been a member of the Council of the British Association of Day Surgery for 6 years and their conference secretary for 3. She served as President-Elect of the Association for two years and took up office as BADS President in June 2016.
The morning concludes with a session from Jo Marsden Consultant Breast Surgeon King’s College Hospital - London Council Member The British Association of Day Surgery, who will discuss 'How do you change practice and is it safe?', looking at:
• How can surgical pathways be changed?
• 10-year same-day breast surgery outcomes
"Lots of trusts have said that they found the NHS Improvement Agency same day pathway template very useful"
"At Kings we stopped using wound drains in non-reconstructive breast cancer surgery. This simplified management and encouraged patients to go home same day. We found that patients wanted to go home but couldn’t before we stopped using drains."
Jo Marsden is a consultant breast surgeon at King’s College Hospital, London. She joined BADS in 2005 to expand her knowledge and insight into the multi-disciplinary approach necessary for developing a same day discharge service for non-reconstructive breast cancer surgery. As a result she piloted a service, which became routine practice with more than 90% of patients discharged safely on the same day. This pathway has been identified as best practice and is now an outcome measure for national breast cancer peer review. She has participated in national workshops organised by NHS Improvement to promote its dissemination and also consulted on the 2012 changes to Best Practice Tariffs aimed at incentivising this pathway. Recently she co-authored a BADS handbook for ambulatory breast cancer surgery.
Also of interest:
National PROMs Summit 2016
Innovations in Emergency Surgery: Development of Emergency Day Surgery Pathways
24 November 2016