News and updates from today's Breast Surgery as Day Surgery conference
Following the chairs introductions, Dr Anna Lipp Consultant Anaesthetist Norfolk and Norwich Hospital & Past President The British Association of Day Surgery, opens the day with a focus on 'The Day Surgery Pathway' looking at:
• Referral pathways
• Patient suitability
• What happens on the day of surgery
In her presentation Dr Lipp said:
'We’re talking about day surgery but a patient’s pathway is going to involve a lot more than one day They will be up and down to the hospital several times and it’s our job to make sure that takes place in as few visits as possible. The really important thing about the pathway is that the patient is given consistent information about the fact that they are going to be a day case patient. '
'For patient having surgery the first port of call is primary care. They will present to their GP with a problem. At this point, the GP is able to consider these three things: Is this problem likely to result in a surgical procedure suitable for a day case? Is this patient potentially suitable to be a day case? The final thing and perhaps the most important thing is that the GP should have some judgement as to whether the patient is fit to be referred for surgery now.'
'For patients with significant co-morbidities, or those that are having major surgeries, its advisable to see an anaesthetist at the same time as they are having their assessment.'
'In terms of the actual pre-operative assessment system, I think the best systems are operated as a nurse-led process. It’s targeted at peri-operative problems, looking at things like anaesthetic issues, or problems with the surgery, and that can all be delivered very safely by trained nurses.'
It’s very helpful to have protocols for all the standard problems, things like, patients on anti-coagulants, patients with a high BMI, patients with diabetes etc, so nurses can go ahead, without having to refer to doctors.'
'For suitable procedures, patients should be able to be a day case. If they have poorly controlled co-morbidities, the answer is to control those co-morbidities, so the patient can be seen as a day case.'
'We know diabetics hate coming into hospital, its the one thing thats sure to throw off their diabetic control. If they can be managed as a day case, it is absolutely preferable.'
'If at all possible try to make sure your day cases go to a dedicated area, make sure your patients know where to go. Try to stagger your admission times if possible, and by that I mean morning and afternoon.'
Mary Stocker Consultant Anaesthetist South Devon Healthcare NHS Foundation Trust President The British Association of Day Surgery, continues with a session on 'Evaluating Performance in Day Surgery', focusing on:
• Measuring quality in day surgery
• Evaluating the pathway
• Measuring outcomes
'How we can evaluate the performance of our day surgery unit and our day surgery service.'
'We have to decide whether we are talking about quantity or quality. There’s very little national reporting of quality.'
'What performance markers do we have? Well we have national targets for quality, and we do have some clinical targets for outcomes and patient satisfaction.'
'We need a multi-professional management team. We can’t do day surgery as one specialty alone.'
We find that units that are discreet from in patient activities have much better outcomes.
It’s not rocket science, it’s about small details making a huge difference to your outcomes.
'We need to monitor outcomes from all stages of this process to really know whether we are getting this right.'
'If we have a good admissions process, our lists will start on time.'
'We telephone all of our patients the day after day surgery and ask them structured questions about pain and nausea.'
'The obese, the less well, the elderly, the diabetic cases, are all patients, that are now considered appropriate for day cases. This is how far they have come over the last 30 years. The only caveat now is that they have stable medical conditions.'
'We know we’ve got financial targets, they’re getting worse and worse and the government has asked us to maximise day surgery, but I would say we should be looking at more like 85% rather than the 75% target,. The NHS plan wants us to treat day surgery as the norm. We believe nearly all surgeries should be day or at least short stay. It really isn’t minor lumps and bumps anymore.'
'The other way you can benchmark your day case rates is the Better Care, Better Values website.'
Terri Baxter Breast CNS King’s College Hospital NHS Foundation Trust, opens the afernoon session with a session on '‘Home by half-past three’: Patient and CNS experience of same day discharge', covering:
• Pre-operative planning
• Post-operative patient support and patient experience
• Nurse-led telephone discharge follow-up and wound management
Also of interest:
Effective Operating Theatres Summit
Friday 7 July 2017
De Vere West One Conference Centre, London
11 May 2017