Rising to the challenges of achieving day surgery targets

Abstract

Summary Day surgery provides high quality and efficient care for a wide variety of surgical procedures. Patients appreciate the rapid recovery and effective analgesia, while the health service benefits from a streamlined service with lower costs. Despite the numerous advantages, day surgery practices vary enormously and many patients are still denied this excellent form of care. Fundamental to improving this situation is a change in emphasis, with day surgery becoming the default option for many surgical procedures – rather than being applied selectively – with inpatient care being used only where specifically indicated. Appropriate patient preparation is facilitated by consultant‐led, nurse‐run preassessment using modern selection criteria; only conditions which will still cause problems a few hours beyond the end of the operation should be barriers to day surgery. Preassessment also provides an excellent opportunity to begin patient education and ensures that pre‐existing pathology is optimally treated. Efficient day surgery is best delivered by a specialised, dedicated, multi‐disciplinary team, but consultant anaesthetists have a major role to play in co‐ordinating policies and providing leadership. Individual anaesthetists should develop techniques that allow their patients to undergo day surgery with minimum stress, maximum comfort and the optimal chance of early discharge. Improving day surgery rates is a win–win situation, with both clinical and financial benefits.

The Quality of Patient Education in Day Surgery by Adult Patients

“…Effective and clear patient education seeks to improve patient knowledge and operational performance, [9][10][11][12][13] optimize patient recovery, shorten hospital stays for patients, improve satisfaction with health care, reduce the risks associated with surgery, [14][15][16][17] as well as help to reduce the pressures on societal health services. 18 Day surgery is an innovative treatment whose popularity and demand is growing all the time. 1,6,19,20 It offers high-quality and effective surgical management for a wide range of procedures 6,18,20 and is a well-designed, cost-effective and people-serving activity.…”

“…1,6,19,20 It offers high-quality and effective surgical management for a wide range of procedures 6,18,20 and is a well-designed, cost-effective and people-serving activity. 6,7,18,19 Surgery and pain treatments constantly develop, so more and more surgeries can be done as a day surgery. 6,[21][22][23] The prevalence of day surgery varies considerably between various countries, from 0% to 90%.…”

“…7,20,24,25 While the health care system benefits from the lower costs of day surgery, patients appreciate a rapid recovery and effective analgesia. 18 Day surgery patients arrive at the hospital on the day of surgery and leave home on the same day 22 or at the latest within 24 hours of surgery. 1,6 Day surgery treatment is therefore fast and efficient.…”

Reasons for delayed patient discharge following day surgery: a literature review

“…One explanation for this could be that written and verbal information regarding discharge arrangements given at preassessment were not clear or sufficient, resulting in patients not fully understanding why they should have a suitable adult escort to take them home (Gilmartin and Wright 2008). Another explanation might be that patients are not completely honest about their home circumstances at pre-assessment, since they are not willing to consider anything other than day surgery (Mottram 2011a (Smith et al 2006).…”

Cost-Effective Utilization of a Private Facility to Perform Outpatient Surgery in Public Hospital Waiting List Patients

“…It is now well validated that surgical outcome of one-day surgery and inpatient care are similar, but at lower costs for one-day surgery [3]. In some countries, more than 50% of all elective surgeries are carried out on an outpatient basis [4]. For hernia repairs, this percentage even increases to 80–90% [5].…”