scholarly journals An audit cycle to investigate discharge analgesia given to day case surgical patients before and after British Association of day surgery guideline implementation

2014 ◽  
Vol 12 ◽  
pp. S23
Author(s):  
Benjamin Faber ◽  
Fraser Walker ◽  
Eamon Lagha ◽  
Sophie Le Gros
Keyword(s):  
Guideline Implementation ◽  
Day Surgery ◽  
Surgical Patients ◽  
British Association ◽  
Day Case ◽  
Before And After ◽  
Audit Cycle

scholarly journals Questionable safety of thyroid surgery with same day discharge

2012 ◽  
Vol 94 (8) ◽  
pp. 543-547 ◽  
Author(s):  
HE Doran ◽  
J England ◽  
F Palazzo
Keyword(s):  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Evidence Base ◽  
Day Surgery ◽  
Hospital Environment ◽  
British Association ◽  
Outpatient Basis ◽  
Day Case ◽  
Increased Risk ◽  
Same Day Discharge

INTRODUCTION Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. METHODS The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed. RESULTS There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. CONCLUSIONS Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.

scholarly journals Day surgery for achalasia cardia: Time for consensus?

2016 ◽  
Vol 98 (2) ◽  
pp. 150-154 ◽  
Author(s):  
DN Naumann ◽  
S Zaman ◽  
M Daskalakis ◽  
R Nijjar ◽  
M Richardson ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Day Surgery ◽  
Complication Rates ◽  
Day Case ◽  
Achalasia Cardia ◽  
Before And After ◽  
Consensus Decision ◽  
Symptom Recurrence

Introduction Laparoscopic Heller’s myotomy (LHM) is the most effective therapy for achalasia of the oesophagus. Most case series of LHM report a length of hospital stay (LOS) >1 day. We present 14 years of experience of LHM to examine the safety and feasibility of LHM as a day case procedure. Methods We retrospectively examined patients undergoing elective LHM for achalasia at our institution between 2000 and 2014. Demographics, episode statistics, prior investigations and interventions were collated. Outcomes, including LOS, complications and re-interventions, were compared for the periods before and after a consensus decision at our institution in 2008 to perform LHM as a day case procedure. Results Sixty patients with a mean age of 41±13 years were included, of whom 58% were male. The median LOS for all patients was 1 day (interquartile range [IQR] 0–2.25). Overall, LHM was performed as a day case in 27 (45%) cases, at 2/26 (7.7%) in the first period versus 25/34 (73.5%) in the second (p<0.01). There were no significant differences in age, gender or previous interventions between day surgery and non-day surgery groups. One patient required subsequent unplanned surgery, while six (10%) needed endoscopic treatment of recurrent symptoms within 12 months. Conclusions LHM can be performed safely as a day case procedure. Complication rates are low, with only a small proportion of patients requiring endoscopic treatment for symptom recurrence within 1 year.

EP.FRI.821 Operative Treatment of Abscesses – Optimising A Timely Route to Theatre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hamza Ikram ◽  
Roland Taylor ◽  
Alexios Dosis ◽  
Jonathan Robinson
Keyword(s):  
Waiting Times ◽  
Day Surgery ◽  
Surgical Service ◽  
Timely Manner ◽  
Day Case ◽  
Incision And Drainage ◽  
The Mean ◽  
Audit Cycle ◽  
American Society ◽  
Operative Notes

Abstract Aim 1st audit cycle to assess whether patients presenting to the acute surgical service had their abscesses incised and drained in a prompt and timely manner. To develop a pathway for improving efficiency Methods All general surgical patients admitted to the surgical admissions unit between 1st September and 31st October 2020 by reviewing clinical and operative notes. Only those patients that had abscesses drained under general anaesthesia. Other specialties abscesses were excluded. Guidelines from the American Society of Colon and Rectal surgeons for draining abscesses acutely were used. Data was collected on various parameters.  Results A total of 62 patients had abscesses drained. The mean age of patients was 32 years. The average waiting time between decision to operate and surgery was 14 hours and 54 minutes. 19% of the patients were sent home after decision was made to operate and brought back in the morning. Conclusion This 1st audit cycle concludes long waiting times and unnecessary overnight stay. A re-audit will be carried out using the same parameters in March 2021. Implementing a dedicated general surgical abscess pathway for patients without significant co-morbidities will improve efficiency and patient satisfaction. References  1. Kumar C, Page R, Smith I, Stocker M, Tickner C, Williams S, et al. Day case and short stay surgery: 2. Anaesthesia. 2011;66(5):417–34.  2. Balakumar R, Samuel N, Jackson A, Butterworth J, Shiwani MH. Day-surgery approach for incision and drainage of an abscess. Surg Pract. 2016;20(4):157–60.

Introducing day case thyroid lobectomy at a tertiary head and neck centre

2021 ◽  
Vol 103 (7) ◽  
pp. 499-503
Author(s):  
Z Sheikh ◽  
V Lingamanaicker ◽  
E Irune ◽  
B Fish ◽  
P Jani
Keyword(s):  
Cost Effective ◽  
Day Surgery ◽  
British Association ◽  
Day Case ◽  
Thyroid Lobectomy ◽  
Number Of Patients ◽  
Same Day Discharge ◽  
Postoperative Haematoma ◽  
The Uk ◽  
Disseminated Disease

Background Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. Methods We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery’s 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. Results In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. Conclusions Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.

Day-case tonsillectomy: is the NHS demanding unobtainable targets?

2014 ◽  
Vol 96 (6) ◽  
pp. 188-190
Author(s):  
A Trinidade ◽  
JS Phillips ◽  
AP Bath
Keyword(s):  
Surgical Procedures ◽  
Day Surgery ◽  
British Association ◽  
Day Case ◽  
Department Of Health ◽  
Audit Commission

In its 2002 document Delivering the NHS Plan, the Department of Health set a target of 75% of all surgical procedures being performed as day-case procedures. 1 Tonsillectomy is quoted as one of the operations in the ‘basket’ of 25 procedures deemed suitable by the Audit Commission and the British Association of Day Surgery (BADS). 2 , 3 With respect to tonsillectomy alone, the target is quoted as 70% for children and 80% for adults. 3

Untersuchungen zur Quantifizierung der Änderung der Skelettmuskeldurchblutung nach Gefäßrevaskularisationen mit einem 99mTechnetiummarkierten Tracer

1990 ◽  
Vol 29 (05) ◽  
pp. 215-220 ◽  
Author(s):  
R. Benning ◽  
K. Nagel ◽  
M. Jugenheimer ◽  
S. Fischer ◽  
S. Worthmann ◽  
...  
Keyword(s):  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Surgical Patients ◽  
Treadmill Test ◽  
Negative Results ◽  
Clinical Observations ◽  
Before And After ◽  
Comparative Results ◽  
First Time ◽  
Percutaneous Transluminal

A new 99mTc-labelled tracer (99mTc-Sestanriibi) was used for the first time to demonstrate the perfusion of the skeletal muscle. In 16 patients with obstructive atherosclerosis of the lower limbs the change of perfusion of thigh and lower leg was studied with SPECT before and after vascular surgery (n = 11) or percutaneous transluminal angioplasty (n = 5). Comparative results of scintigraphic measurements and clinical observations (ancle-arm pressure, treadmill test) in 10 surgical patients (14 operated legs) showed correct positive or negative results in 86% (12/14).

scholarly journals A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

2016 ◽  
Vol 98 (7) ◽  
pp. 468-474 ◽  
Author(s):  
TE Pidgeon ◽  
U Shariff ◽  
F Devine ◽  
V Menon
Keyword(s):  
Computed Tomography ◽  
Primary Outcome ◽  
Surgical Patients ◽  
Clinic Attendance ◽  
Early Evaluation ◽  
Admission Rates ◽  
Before And After ◽  
Age Range ◽  
Surgical Clinic

Introduction In 2013 our hospital introduced an in-hours, consultant-led, outpatient acute surgical clinic (ASC) for emergency general surgical patients. In 2014 this clinic was equipped with a dedicated ultrasonography service. This prospective cohort study evaluated this service before and after the introduction of ultrasonography facilities. Methods Data were recorded prospectively for all patients attending the clinic during 2013 and 2014. The primary outcome was patient destination (whether there was follow-up/admission) after clinic attendance. Results The ASC reviewed patients with a wide age range and array of general surgical complaints. In 2013, 186 patients attended the ASC. After the introduction of the ultrasonography service in 2014, 304 patients attended. In 2014, there was a reduction in the proportion of patients admitted to hospital from the clinic (18.3% vs 8.9%, p=0.002). However, the proportion of patients discharged after ASC review remained comparable with 2013 (30.1% in 2013 vs 38.8% in 2014, p=0.051). The proportion of patients undergoing computed tomography (CT) scans also fell (14.0% vs 4.9%, p<0.001). Conclusions The ASC assessed a wide array of general surgical complaints. Only a small proportion required hospital admission. The introduction of an ultrasonography service was associated with a further reduction in admission rates and computed tomography.

Compliance with the Data Protection Acts in a psychiatric department: a complete audit cycle

2014 ◽  
Vol 31 (2) ◽  
pp. 125-130
Author(s):  
A. Hassab Errasoul ◽  
M. Cannon ◽  
D. Cotter
Keyword(s):  
Data Protection ◽  
Working Hours ◽  
Educational Interventions ◽  
Hospital Data ◽  
Staff Members ◽  
Before And After ◽  
Audit Cycle ◽  
Collection Practices ◽  
Psychiatric Department ◽  
The Impact

Aim1) to assess compliance with the Data Protection Acts (DPA) by a Department of Psychiatry in a general hospital, 2) to implement measures that are likely to maximize compliance with the hospital data protection policy, 3) to close the audit cycle by assessing the impact of such measures on departmental compliance with the DPA over five months period.MethodAn individual, anonymised staff questionnaire on data collection practices, procedure of disclosure of data to third parties and previous training on DPA was used to collect information from the department staff. The premises were inspected at different times over a week period using structured checklist. Default points were recorded during each inspection. Post-audit interventions included a mixture of educational interventions and practical solutions. A re-audited took place five months later using the same method.ResultsThe baseline audit demonstrated significant lack of compliance with the DPA among staff members and lack of staff training on the DPA. Following the interventions, staff awareness of the requirements of the act rose which in turn lead to better adherence to recommend practices in data handling and to mean default points dropped significantly. Management of manual files appears to constitute the biggest problem in this audit. Daytime breaks were found to pose higher risk to stored data compared with before and after working hours.ConclusionsA combination of educational and practical interventions including training of staff on the DPA results in overall improvement in compliance and reduction in default points. However, management of manual (physical) data proves to be more difficult and hence will need more input.

Day case surgery

1991 ◽  
Vol 29 (6) ◽  
pp. 23-24 ◽  
Keyword(s):  
Day Surgery ◽  
Waiting Lists ◽  
Day Case ◽  
Day Case Surgery ◽  
Surgical Services ◽  
Case Surgery ◽  
Working Day

Long waiting lists, shortage of nurses and lack of resources bedevil surgical services. One solution has been the use of day surgery, patients being admitted and discharged within the working day. Day surgery, balanced by a corresponding reduction in inpatient surgical beds, helps hospital finances1 but do patients benefit and how do day units work? These questions have recently been addressed in two national reports.2,3

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