ENT day surgery in England and Wales – an audit by the Royal College of Surgeons (Eng.) Comparative Audit Service

1998 ◽  
Vol 112 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Peter M. Brown ◽  
Sarah Fowler ◽  
Rowena Ryan ◽  
Raymond Rivron
Keyword(s):  
Detailed Analysis ◽  
Royal College ◽  
Admission Rate ◽  
Day Surgery ◽  
Case Mix ◽  
England And Wales ◽  
Comparative Audit ◽  
Service Data

AbstractAn audit of day surgery was carried out by the Royal College of Surgeons (Eng.) Comparative Audit service. Data from 121 respondents on over 3 962 day cases were analysed from both retrospective information and from prospective individual patient proformas. The day surgery rate is 31 per cent. The variability of facilities for day-surgery, the timing of lists, type of anaesthetic used and case-mix are discussed. Outcome and the reasons for admission to an overnight bed are analysed. The overall admission rate was found to be 2.8 per cent (range 0.6–19.5 per cent between consultants). Seventy per cent of ENT day-surgery was performed on morning lists which have a lower admission rate than afternoon lists. The main reasons for admission are vomiting 30 per cent, haemorrhage 20 per cent and inadequate recovery from anaesthetic 22 per cent. A more detailed analysis of reasons for admission were given for tonsillectomy, adenoidectomy, FESS, and grommets. Recommendations are given which might increase the scope of safe day-surgery and reduce admission rate.

Re-appraising and Re-classifying: a New Look at the Corpus of Miniature Socketed Axes from Britain

2020 ◽  
Vol 75 (1) ◽  
pp. 1-27
Author(s):  
Alex Bliss
Keyword(s):  
Spatial Distribution ◽  
Data Collection ◽  
Detailed Analysis ◽  
Significant Proportion ◽  
Direct Result ◽  
Object Type ◽  
England And Wales ◽  
Extensive Data ◽  
Metal Artefacts ◽  
The Subject

The advent of the Portable Antiquities Scheme (PAS) has added a great deal to our understanding of prehistoric metal artefacts in England and Wales, namely in expanding enormously the corpuses of objects previously thought to be quite scarce. One such artefact type is the miniature socketed 'votive' axe, most of which are found in Wiltshire and Hampshire. As a direct result of developing such recording initiatives, reporting of these artefacts as detector finds from the early 2000s onwards has virtually trebled the number originally published by Paul Robinson in his 1995 analysis. Through extensive data-collection, synthesising examples recorded via the PAS with those from published excavations, the broad aims of this paper (in brief) are as follows: firstly, produce a solid typology for these artefacts; secondly, investigate their spatial distribution across England and Wales. As a more indirect third aim, this paper also seeks to redress the imbalance of focus and academic study specifically applying to Hampshire finds of this object type, which despite producing a significant proportion of the currently known corpus have never been the subject of detailed analysis.

Psychiatric Disorders among the Chronic Sick in Hospital

1948 ◽  
Vol 94 (394) ◽  
pp. 33-45 ◽  
Author(s):  
James W. Affleck
Keyword(s):  
New York ◽  
Psychiatric Patients ◽  
Admission Rate ◽  
Age Group ◽  
Aged Patients ◽  
England And Wales ◽  
Mental Hospitals ◽  
Large Numbers ◽  
Rising Incidence ◽  
Marked Tendency

Introduction.The Admission of Aged Psychiatric Patients to Institutions.It has recently been pointed out (Lewis, 1946) that between the years 1907 and 1937 the number of first-attack admissions of patients of 65 years and over, into the mental hospitals of England and Wales, differs considerably from analogous American figures. In Britain, using statistics supplied by the Board of Control for England and Wales, there was a marked tendency for the incidence of this group to decline, whereas in America, using statistics from New York Mental Hospitals Board, there was a marked increase. An explanation is found in the assumption that in England large numbers of cases which would be relevant to the statistics, were looked after in other institutions or at home, whereas in America less alternative accommodation was provided. It is doubtful, had the investigation been continued up to the present date, if the statistical divergence would have been found to continue. The incidence of first-attack admissions of those over 65 has, of course, a more subtle significance than a simple admission-rate for an age-group, or even a first-admission-rate, but the present impression in British Mental Hospitals is that admission of old persons—even first-attack admissions—has increased, especially during the war years. Post (1942) demonstrated this rising incidence of aged patients by analysing the admissions to Edinburgh Royal Mental Hospital from 1904 to 1942.

scholarly journals Day-Case Septoplasty and Unexpected Re-Admissions at a Dedicated Day-Case Unit: A 4-Year Audit

2006 ◽  
Vol 88 (2) ◽  
pp. 202-206 ◽  
Author(s):  
Christos Georgalas ◽  
Rupert Obholzer ◽  
P Martinez-Devesa ◽  
G Sandhu
Keyword(s):  
Patient Satisfaction ◽  
Admission Rate ◽  
Day Surgery ◽  
Case Note ◽  
Day Case ◽  
Retrospective Case ◽  
Patient Factors ◽  
Factors Associated ◽  
Septal Surgery ◽  
Submucous Resection

INTRODUCTION Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2–3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We have reviewed practice over 4 years in our institution to identify surgical and patient factors associated with unexpected admission following septoplasty. PATIENTS AND METHODS A retrospective case note based audit of day-case septoplasty procedures reviewed at the end of each year between October 1998 and October 2002. RESULTS A total of 432 septal surgery procedures were performed, comprising 378 septoplasties and 54 submucous resections. Thirty-eight patients were admitted, overwhelmingly because of haemorrhage in the immediate postoperative period, giving an overall admission rate of 8.8% within the first 24 h. Factors associated strongly with re-admission were the use of intranasal splints, the performance of revision surgery, submucous resection (as opposed to septoplasty) and, less so, the performance of additional procedures and the peri-operative administration of diclofenac. There was no correlation between unexpected admission and grade of surgeon, surgical technique or any of the patient factors analysed. CONCLUSIONS The unexpected admission rate of septal surgery performed at our unit is above that recommended for day-case procedures, but is within the range previously published. Patient satisfaction with day-case septoplasty has been shown to be high. We believe that septoplasty should be performed in this setting but there is a significant chance that patients may need admission, and a pathway should be in place for this to occur with minimal disruption to the patient.

scholarly journals 262 Analysis of the Factors Contributing to Unplanned Admissions of Surgical Day Cases

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Al-Zubaidy ◽  
C Greaney ◽  
H Malik ◽  
F Awan
Keyword(s):  
Admission Rate ◽  
Incisional Hernia Repair ◽  
Cost Effective ◽  
Day Surgery ◽  
Root Cause ◽  
Background History ◽  
Unanticipated Admission ◽  
Almost All ◽  
Unplanned Admissions ◽  
Hospital Acquired

Abstract Introduction Day surgery has many benefits including a reduction in waiting lists, cancellations, hospital acquired infections and need for inpatient beds. It is also highly cost effective. The aim of this study is to identify which factors lead to the unanticipated admission of day cases, in order to adjust future patient selection, and retain efficiency Method A list of day cases that took place in 2017 was obtained from the HIPE department in St. Luke’s General Hospital. Day case patients who required admission were retrospectively analysed with the use of patient charts. Patient factors such as age, gender and co morbidities were recorded. The root cause of admission was identified, and the data collated. Results 457-day cases took place during 2017. 35/457 patients were admitted postoperatively (admission rate of 7.8%). The majority of patients were admitted post cholecystectomy (22) and incisional hernia repair (8). Surgical factors were responsible for almost all admissions. Conclusions Surgical factors/complications are not always predictable, but a thorough review of a patient’s background history and imaging can lead to the identification of patients, who should be directed away from day surgery, minimising the need for unexpected admissions, and maximising the efficiency of the unit.

A confidential comparative audit of stapedectomies: results of the Royal College of Surgeons of England Comparative Audit of ENT Surgery 1994

1995 ◽  
Vol 109 (4) ◽  
pp. 317-319 ◽  
Author(s):  
P. Harkness ◽  
P. Brown ◽  
S. Fowler ◽  
H. Grant ◽  
J. Topham
Keyword(s):  
Royal College ◽  
Complication Rate ◽  
Ent Surgery ◽  
Comparative Audit

AbstractThis paper presents the results of a national confidential comparative audit of stapedectomy: 185 operations by 28 consultants over a two-year period were retrospectively analysed. This included 10 revision procedures. Small fenestra stapedectomies accounted for 63 per cent of the total. Thirty-nine per cent of consultants operated on the second ear. Of the 168 stapedectomies in which the hearing change was known at six months, 87 per cent achieved improved hearing, eight per cent had no change and five per cent were worse. The overall complication rate was 30 per cent with a ‘dead ear’ rate of two per cent.

scholarly journals 1565 In Covid-19 Pandemic, Following the Updated Royal College of Surgeons of England Guidelines in Management of Acute Appendicitis; A General District Hospital Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Dorra ◽  
M Abdellatif ◽  
W Fahmy ◽  
Y Salama
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Royal College ◽  
Conservative Management ◽  
District Hospital ◽  
Admission Rate ◽  
Operative Management ◽  
Operative Intervention ◽  
Coding System ◽  
Conservative Group

Abstract Aim The Aim of the study is assessment of the compliance with the updated Royal College of Surgeons of England (RCS) guidelines in management of acute appendicitis in a general district hospital during COVID-19 pandemic. Conservative treatment of acute appendicitis is encouraged unless unresponsiveness to treatment or complications ensues. Method Collection of retrospective data using hospital coding system was done from 63 patients medical records who were diagnosed with acute appendicitis from April 2020 to June 2020. Results The collected data analysis showed adherence to conservative treatment in 16 out of 63 (16/63) patients (25.4%). It succeeded in 10/16 patients (63 %). 6/16 patients were switched to operative intervention (37 %). There were no complications in patients who needed operative intervention after failure of conservative management. Operative management was primarily chosen in 47/63 patients (74.6 %). Re-admissions were 3/16 patients (18.75 %) in conservative group in comparison to 1/47 patient (2.12 %) in primarily operative group. Conclusions The work showed a promising rate of success of conservative treatment. However, there is a low level of compliance with RCS guidelines in management of acute appendicitis during COVID-19 pandemic. The study showed increased re-admission rate for conservative management versus primarily operative management pathways. No complications were detected in cases who needed operative intervention after failure of conservative management. Re-auditing is to follow. The study recommends national comparison of data as it might be worthwhile considering primary management of acute appendicitis.

scholarly journals Outcome after Day-Care Surgery in a Major Teaching Hospital

1993 ◽  
Vol 21 (6) ◽  
pp. 822-827 ◽  
Author(s):  
G. A. Osborne ◽  
G. E. Rudkin
Keyword(s):  
General Anaesthesia ◽  
Teaching Hospital ◽  
Admission Rate ◽  
Community Support ◽  
Day Surgery ◽  
Patient Acceptance ◽  
Complication Rates ◽  
Hospital Admission Rate ◽  
Satisfactory Outcome ◽  
Care Surgery

Outcome has been measured for 6000 consecutive procedures in a major public teaching hospital day surgery unit. The unanticipated hospital admission rate was 1.34% and surgery-related admissions (0.95%) exceeded those related to anaesthesia (0.13%). Perioperative complications related to surgery (1:105) were more frequent than those related to anaesthesia (1:176) and pre-existing medical problems (1:500). Anaesthesia-related complications were more frequent with general anaesthesia (1:114) than with local anaesthesia plus sedation (1:780) or regional anaesthesia (1:180). Recovery times after general anaesthesia were longer than after other anaesthetic techniques but did not correlate with patient age (r = 0.04; P = 0.02) and only weakly correlated with procedure duration (r = 0.21; P < 0.01). At early follow-up, 4.0% of patients had presented to a local medical practitioner and 3.1% to a hospital accident and emergency service, usually for minor problems. Take home analgesia was adequate for 95% of patients and 98.9% were happy with the day surgery service. Day surgery in a teaching hospital can provide satisfactory outcome, with low complication rates, high patient acceptance and low community support requirements after patient discharge.

scholarly journals PSU25 THE CHANGE OF CASE MIX INDEX IN THE PUBLICLY FINANCED HUNGARIAN ONE-DAY SURGERY CARE

2019 ◽  
Vol 22 ◽  
pp. S896
Author(s):  
R. Pónusz ◽  
D. Kovács ◽  
I. Boncz ◽  
D. Endrei
Keyword(s):  
Day Surgery ◽  
Case Mix ◽  
Case Mix Index

scholarly journals Laparoscopic Cholecystectomy as a Day Surgery Procedure

1996 ◽  
Vol 24 (2) ◽  
pp. 231-236 ◽  
Author(s):  
R. J. Singleton ◽  
G. E. Rudkin ◽  
G. A. Osborne ◽  
D. S. Watkin ◽  
J. A. R. Williams
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Recovery Room ◽  
Admission Rate ◽  
Day Surgery ◽  
Nausea And Vomiting ◽  
Day Case ◽  
Hospital Admission Rate ◽  
Admission Rates ◽  
Surgery Patient ◽  
At Home

Outcome is presented for 40 consecutive laparoscopic cholecystectomies performed in a public teaching hospital day surgery unit. The unanticipated hospital admission rate on the day of surgery was 17.5% (seven patients) and the majority of these (12.5%; five patients) were due to surgery-related considerations. Two other admissions were due to nausea and vomiting. One patient was admitted to hospital on the second postoperative day with nausea and vomiting. Procedure duration for the day cases averaged 98 minutes (SD25; range 60–167). Recovery room times before discharge averaged 272 minutes (SD 58; range 125–365). Each day surgery patient averaged 3.3 postoperative home visits from community nurses. Most patients (94%) mobilized at home by the second postoperative day and 85% resumed normal activities of daily living by two weeks. At follow-up, 25 patients (76%) stated they were happy to spend the first night at home, but seven (21%) would have preferred to remain in hospital for the first postoperative night. Laparoscopic cholecystectomy can be performed successfully as a day–case procedure, but long operating and recovery room times and potentially high admission rates suggest that these factors should be considered in cost equations for day-case management of this procedure.

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