Single hospital visit day case laparoscopic hernia repair without prior outpatient consultation is safe and acceptable to patients

Carty, Nick; Curtis, Nathan; Ranaboldo, C. J.

doi:10.1007/s00464-016-4929-3

Cited by 10 publications

(4 citation statements)

References 19 publications

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“…In order to meet increased demand for economic efficiency and to improve service provision NHS trusts can implement time efficient strategies such as pooled operating lists [24] , non-operator or anaesthetist led pre-assessment clinics [25] and even surgery with no pre-operative outpatient clinic beforehand [26] . The advantages can include reducing waiting times and improved patient experience.…”

Section: Discussionmentioning

confidence: 99%

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

O'Brien

Natarajan

Shaikh

2017

Annals of Medicine &Amp; Surgery

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BackgroundThe UK Supreme Court recently ruled that when consenting patients for treatments or procedures, clinicians must also discuss any associated material risks. We surveyed medical staff at a large UK teaching hospital in order to ascertain knowledge of consent law and current understanding of this change.Materials and methodsEmail survey sent to medical staff in all specialities at Norfolk and Norwich University Hospital in February 2016.Results245 responses (141 Consultants and 104 junior doctors, response rate 32%). 82% consent patients for procedures at least monthly and 23% daily. 31% were not familiar with the concept of material risk. 35% were familiar with the recent change in consent law, 41% were not. 18% were “very uncertain” and 64% “a little uncertain” that their consenting process meets current legal requirements. >92% think that landmark cases and changes in law should be discussed through professional bodies and circulated better locally.ConclusionThe majority were not familiar with the concept of material risk and recent legal changes. A majority were not confident that their practice meets current requirements, suggesting that recent changes in consent law may not be widely understood at this hospital. We suggest more guidance and education may be necessary than is currently available. Increased understanding of recent changes to consent law will reduce the risk taken by NHS trusts and offer patients a service compliant with Supreme Court guidance.

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Section: Discussionmentioning

confidence: 99%

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

O'Brien

Natarajan

Shaikh

2017

Annals of Medicine &Amp; Surgery

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“…In the United Kingdom, for example, such services for laparoscopic hernia repairs and cholecystectomies have been safely piloted in the past few years. In one pilot study, among 517 patients referred with hernias, approximately 2% were converted to a pre-operative in-person ambulatory care surgical visit after telephone consultation and 0.8% experienced a same-day surgery cancellation rate [33]. Among 166 patients referred for cholecystectomy, 8% were converted to a pre-operative surgical visit, 5% presented to the emergency room while awaiting surgery, and there were no same-say surgery cancellations [34].…”

Section: Discussionmentioning

confidence: 99%

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

Ulloa

Russell

Chen

et al. 2017

BMC Health Serv Res

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BackgroundElectronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).MethodsRetrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.ResultsIn 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.ConclusionEconsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.

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“…Such protocols are developed for reduction of patient visits to the hospital. Many more hernia repairs and other day case procedures could be carried out using similar protocols [16,17].…”

Section: Identification Of Risk Factors Optimization Of Patient's Hementioning

confidence: 99%

Hernia in Ambulatory Surgery Centre

Šeparović¹,

Augustin²

2017

Hernia

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Surgical treatment of hernia is one of the most common procedures in general population. Since it was traditionally treated as "non-complex" operation, it is an ideal procedure for ambulatory surgery settings. Ambulatory surgery is superior to in-hospital treatment due to faster patient flow, reduced patient stress, early mobilization, and lower overall costs. Unforeseen hospitalization can be avoided with meticulous patient selection, education and preparation, use of local anesthesia whenever possible, and avoidance of opioids in early postoperative period.

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Single hospital visit day case laparoscopic hernia repair without prior outpatient consultation is safe and acceptable to patients

Abstract: Single-visit surgery appears to extend the patient benefits of laparoscopy by reducing hospital visits without compromising safety. Single hospital visit hernia surgery for unselected primary care referrals is possible and acceptable to patients.

Cited by 10 publications

References 19 publications

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

Hernia in Ambulatory Surgery Centre

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