The preceding paper deals with the method of discharging patients home on the day of operation, as seen by the surgeon. The purpose of this article is to present the general practitioner's point of view.For years it has been the custom to admit a patient to a hospital bed for anything but the most trivial minor operations. The general practitioner did not deal with the patient again until the whole surgical episode had been completed, and, apart from declaration of fitness for work, had
Follow-upWe ourselves are fortunate in having a local health authority nurse attached to the practice ; this ensures complete liaison between doctor and nurse. Usually both doctor and nurse visit on the first two or three days after operation; the nurse then continues to visit daily, reporting any problems which may arise. Usually the doctor will visit once more when the nurse removes the sutures.Two of our hernia cases developed low-grade fevers during the first two days, but these settled without sequelae.In the 25 cases mentioned above the only postoperative complication was a haematoma of the breast in a patient who had had a fibroadenoma removed. This was allowed to localize, and was evacuated a few days later-as an outpatient.All patients were allowed up to the toilet from the beginning and were encouraged to be ambulant from the second day onwards. Occasionally it was hard to get relatives to accept that early mobilization was important, but all co-operated well to this end when the reasons were given. Altogether the whole process was accepted very naturally by patients and relatives.
DiscussionThe advantage of saving hospital beds by this method of dealing with operative cases is obvious. How then does it affect the patient and the general practitioner ? With regard to the patient there are two apparent disadvantages. Firstly, he will travel by ambulance within a few hours of having had an operation. He will also be at home without the constant presence of professional medical aid. In practice these objections appear to be more theoretical than real. With adequate sedation before leaving hospital all the patients we dealt with had a relatively comfortable ride home. When at home they were seen by one of us within a short time and any complications were looked for. Sedation was given if required and the BRmm MEDICAL JOURNAL
As libraries of all types and sizes continue to re-envision themselves to remain relevant in a rapidly changing information landscape, the single service point is visible evidence of this effort. In a complex environment, combining formerly disparate functional or service units is for many libraries both an innovative and effective way to manage resources and services. It is the intent of this overview to look beyond these issues to find similarities in theme and application that may be useful for those considering implementation of a one-stop model.
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