Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital

Abstract

BackgroundThe increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery.MethodsWe included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout.ResultsWe included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008.ConclusionsThe implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay.

The impact of a structured preoperative protocol on day of surgery cancellations

“…Data analyses were conducted using spss version 22.0 software. For the analysis of changes in cancellation rates, Student's t test was recommended (Dexter, Marcon, Epstein, & Ledolter, ) and had been previously used (Deng et al., ; Hovlid et al., ; Ortiga et al., ). The Z test has a single critical value that makes it more convenient than Student's t test, which has separate critical values for each sample size.…”

“…Preoperative nurse practitioners are acknowledged as highly qualified, independent healthcare providers, and the implementation of nurse practitioner-managed preoperative evaluation clinics is strongly recommended (Sebach, Rockelli, Reddish, Jarosinski, & Dolan, 2015). Implementation of preoperative units or the development of structured and patient-centred preoperative care models has been demonstrated to be an effective strategy in shortening the length of stay, improving bed management (Ortiga et al, 2010) and reducing DOS cancellations in general (Bathala, Tardolli, Jaramillo, Morgan, & Thomas, 2013;Gheysari, Yousefi, Soleymani, & Mojdeh, 2016;Hovlid, Bukve, Haug, Aslaksen, & von Plessen, 2012;McKendrick, Cumming, & Lee, 2014;Sebach et al, 2015;Siragusa, Thiessen, Grabowski, & Young, 2011) and in children's hospitals (Higson & Finlay, 2010). Patients appreciate new individualised interventions, as they feel involved in preoperative planning and scheduling as patient autonomy increases (Hovlid, von Plessen, Haug, Aslaksen, & Bukve, 2013).…”

“…The main categories were as follows: Resource-related reasons (no time for operation/rush, equipment unavailable, cancelled because of emergency procedure, operating room nursing staff were unavailable, a surgeon was unavailable, or a bed was not available), Patient unfit for operation (patient unsuitable for operation or patient unsuitable for anaesthesia), Other reasons (nonspecific reasons or administrative mistakes), Patient did not turn up and No need for operation were used originally. Data analyses were conducted using SPSS version 22.0 software.For the analysis of changes in cancellation rates, Student's t test was recommended(Dexter, Marcon, Epstein, & Ledolter, 2005) and had been previously used(Deng et al, 2015;Hovlid et al, 2012;Ortiga et al, 2010). The Z test has a single critical value that makes it more convenient than Student's t test, which has separate critical values for each sample size.…”

Effectiveness of a new short-stay unit for elective low complexity patients’ admissions to improve patient flow

“…Occasionally, there could be a demand peak and not enough SSU-beds to allocate all the patients. If that was the case, there was the possibility to prepare some short-stay patients in the chairs from the surgery reception unit [16] , and locate them in a SSU-bed after the surgery, limiting the need of last moment cancellation to the minimum possible. Besides we did not conduct a survey to test patients' satisfaction with the SSU, we can deduce that the decrease of last moment cancellations indicator had a high impact in terms of improving patients' experience and perceived quality of care.…”

Alternatives to conventional hospitalization for improving lack of access to inpatient beds: a 12-year cross-sectional analysis

“…In accordance, our option was not to add more beds, but to strongly reinforce a greater use of alternatives to standard hospitalization, either already existing or new, either for emergency or scheduled patients, either surgical or medical [31,[48][49][50][51] . This was not a financially-motivated efficiency goal, but certainly a clinically-inspired intervention for a more appropriate use of our inpatient beds.…”