Admission and discharge policy for paediatric adenoidectomy and tonsillectomy – a rural perspective

1998 ◽  
Vol 112 (11) ◽  
pp. 1047-1051 ◽  
Author(s):  
P. Murthy ◽  
M. R. Laing
Keyword(s):  
General Practitioners ◽  
Surgical Procedures ◽  
Nursing Staff ◽  
Prospective Audit ◽  
Day Case ◽  
Discharge Policy ◽  
Same Day Discharge

AbstractAdenoidectomy and tonsillectomy are amongst the most common surgical procedures carried out in children. We undertook a prospective audit in the Highlands of Scotland to document the views of general practitioners, parents, nursing staff and anaesthetists on admission and discharge policy. Of responses from 149 general practitioners, 119 (80 per cent) were in favour of change to same day admission and 22 (15 per cent) were not in favour. For change to same day discharge for adenoidectomy, 55 (37 per cent) were in favour and 81(54 per cent) were not in favour. For change to next day discharge for tonsillectomy, the figures were 51(34 per cent) and 89 (60 per cent) respectively. Responses from 14 trained paediatric nurses comprised 13 not in favour of same day admission, six in favour and seven not in favour of same day discharge for adenoidectomy and all 14 not in favour of same day discharge for tonsillectomy. All eight Consultant anesthaetists approached were happy with a change in policy to same day admission for children who were otherwise fit and well. Thirty-seven parents (70 per cent) preferred previous day admission and 14 (29 per cent) were happy with same day admission for their children. On the basis of these results, day-case adenoidectomy or tonsillectomy is not being considered in this area. Moves have been made, however, toward a policy of same day admission and next day discharge.

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.

Motivative measures aimed at increasing the efficiency of labor of medical workers

2021 ◽  
pp. 54-61
Author(s):  
Tatyana Vladimirovna Bessonova ◽  
Svetlana Vladimirovna Kropotova
Keyword(s):  
General Practitioners ◽  
Nursing Staff ◽  
Working Environment ◽  
Specialized Department ◽  
Practical Recommendations

The aim of the study is to correct the motivational activities of the specialized department and the department of general practitioners of the Samara City Polyclinic No. 10. Results:.The comparison of the factors that form the attitude to work in the medical and nursing staff of the specialized department and the department of general practitioners; the zones of tension of satisfaction with work of the medical and nursing staff of the department of general practitioners were identified; the zones of tension of satisfaction with work of the medical and nursing staff of the specialized department were identified; the ranking of the zones of tension of dissatisfaction with the factors of the working environment for all groups of respondents was carried out. Conclusion. Correction of motivational measures made it possible to formulate practical recommendations to improve the efficiency of the work of medical workers.

scholarly journals Surprise met in minor ops

2010 ◽  
Vol 92 (4) ◽  
pp. e24-e26
Author(s):  
Stephen Mulgrew ◽  
Richard Newton ◽  
Anna Khoo ◽  
David Camp
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Surgical Procedures ◽  
Lung Carcinoma ◽  
Model Of Care ◽  
Sebaceous Cyst ◽  
Metastatic Lung ◽  
Specialist Nurses ◽  
Metastatic Lung Carcinoma ◽  
Training And Support

The case of a woman who was initially diagnosed as having a sebaceous cyst but who died from metastatic lung carcinoma 2 weeks after her initial ’minor op’ procedure. Minor surgical procedures are increasingly being performed by specialist nurses and by general practitioners in primary care. However, such non-experts may lack the resources to cope with surprises such as was found in this case. It is, therefore, imperative that adequate training and support is provided as the model of care changes.

Another Style of Psychogeriatric Service

1977 ◽  
Vol 130 (2) ◽  
pp. 123-126 ◽  
Author(s):  
A. A. Baker ◽  
R. J. F. Byrne
Keyword(s):  
Social Services ◽  
General Practitioners ◽  
Nursing Staff ◽  
Community Support ◽  
Day Hospital ◽  
Hospital Nursing

SummaryThis paper describes a psychogeriatric service in Gloucestershire. Agreement on policies was reached with general practitioners, Social Services, other psychiatrists and hospital nursing staff. The day hospital is regarded as the preferred area of treatment for a wide variety of patients, including the severely demented. In this service less than five per cent of admissions appear to become long-stay. With emphasis on day hospital and community support the number of beds for this type of patient recommended by DHSS may be excessive.

scholarly journals ‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
A. Solodkyy ◽  
A. R. Hakeem ◽  
N. Oswald ◽  
F. Di Franco ◽  
S. Gergely ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Preoperative Assessment ◽  
High Volume ◽  
District General Hospital ◽  
Day Case ◽  
Day Case Surgery ◽  
Overnight Stay ◽  
Same Day Discharge ◽  
Case Surgery ◽  
Overnight Stays

Introduction. Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. British Association of Day Case Surgery recommends at least 60% of LCs be performed as day cases. The aim of this study was to assess our rate of true day case LCs and review factors preventing same-day discharge. Methods. We prospectively collected data of all elective LCs performed in a district general hospital over 32 months. Results. 500 patients underwent LC during this period; 438 (88.2%) patients were planned day cases and 59 patients (11.8%) planned overnight stays. Of the planned day cases, 75.8% (n=332) were discharged on the same day and 106 (24.2%) had unexpected overnight stay (UOS). Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. Drain insertion, longer operations, and late recovery departure were the main reasons for UOS. There were more complications in this group compared to day cases. Conclusions. This unit has a high ‘true day case’ rate of 75.8%. High BMI and ASA3 should not be absolute contraindications to day case surgery. The majority of unexpected overnight stays are unavoidable but may be reduced by patient selection, stringent preoperative assessment, operation scheduling, and reduction in unnecessary drain insertion.

scholarly journals Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gyorgy Lovasz ◽  
Attila Aros ◽  
Ferenc Toth ◽  
John Va Faye ◽  
Marco La Malfa
Keyword(s):  
Day Case ◽  
Urine Retention ◽  
Inpatient Ward ◽  
Same Day Discharge ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty ◽  
Orthopaedic Ward ◽  
Hospital Stays ◽  
Total Knee ◽  
Satisfaction Rates

Abstract Purpose We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. Methods 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. Results 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

scholarly journals Day-case open reduction for developmental dysplasia of the hip

2021 ◽  
Vol 2 (4) ◽  
pp. 271-277
Author(s):  
Michael Flatman ◽  
Ben H. Barkham ◽  
Eyal Ben David ◽  
Andrea Yeo ◽  
Joanne Norman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Open Reduction ◽  
Corrective Osteotomy ◽  
Length Of Hospital Stay ◽  
Pain Scale ◽  
Developmental Dysplasia ◽  
Day Case ◽  
Satisfaction Questionnaire ◽  
Same Day Discharge ◽  
Dysplasia Of The Hip

Aims Open reduction in developmental dysplasia of the hip (DDH) is regularly performed despite screening programmes, due to failure of treatment or late presentation. A protocol for open reduction of DDH has been refined through collaboration between surgical, anaesthetic, and nursing teams to allow same day discharge. The objective of this study was to determine the safety and feasibility of performing open reduction of DDH as a day case. Methods A prospectively collected departmental database was visited. All consecutive surgical cases of DDH between June 2015 and March 2020 were collected. Closed reductions, bilateral cases, cases requiring corrective osteotomy, and children with comorbidities were excluded. Data collected included demographics, safety outcome measures (blood loss, complications, readmission, reduction confirmation), and feasibility for discharge according to the Face Legs Activity Cry Consolidability (FLACC) pain scale. A satisfaction questionnaire was filled by the carers. Descriptive statistics were used for analysis. Results Out of 168 consecutive DDH cases, 16 patients fit the inclusion criteria (age range 10 to 26 months, 13 female). Intraoperative blood loss ranged from "minimal" to 120 ml, and there were no complications or readmissions. The FLACC score was 0 for all patients. The carers satisfaction questionnaire expressed high satisfaction from the experience with adequate information and support provided. Conclusion Open reduction in DDH, without corrective osteotomy, is safe and feasible to be managed as a day case procedure. It requires a clear treatment pathway, analgesia, sufficient counselling, and communication with carers. It is even more important during the COVID-19 pandemic when reduced length of hospital stay is likely to be safer for both patient and their parents. Cite this article: Bone Joint Open 2021;2(4):271–277.

scholarly journals Introduction of Day Case Hip and Knee Replacement Programme at an Inpatient Ward is Safe and May Expedite Shortening of Hospital Stays of Traditional Arthroplasties

2021 ◽  
Author(s):  
Gyorgy Lovasz ◽  
Attila Aros ◽  
Ferenc Toth ◽  
John Va Faye ◽  
Marco La Malfa
Keyword(s):  
Day Case ◽  
Urine Retention ◽  
Inpatient Ward ◽  
Same Day Discharge ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty ◽  
Orthopaedic Ward ◽  
Hospital Stays ◽  
Total Knee ◽  
Satisfaction Rates

Abstract Purpose: We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward.Methods: 200 patients underwent elective, unilateral primary day case total hip (THA, n=94), total knee (TKA, n=60) and unicondylar knee replacements (UKA, n=46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n=6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period.Results: 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5 %), urine retention (3 %) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion: Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

Oxford Guidelines for adult day-case tonsillectomy

2021 ◽  
pp. 175045892110310
Author(s):  
Konstantinos Chaidas ◽  
Claire Winterborn
Keyword(s):  
Patient Selection ◽  
Patient Comfort ◽  
Healthcare Staff ◽  
Key Factors ◽  
Close Collaboration ◽  
Day Case ◽  
Optimal Care ◽  
Know How ◽  
Same Day Discharge ◽  
Allied Healthcare

Oxford guidelines were developed after critically reviewing the existing literature and aim to assist anaesthetists, surgeons and allied healthcare staff in providing optimal care for patients undergoing tonsillectomy as a day-case procedure. Appropriate patient selection, provision of robust analgesia, antiemesis, perioperative warming and hydration are key factors to ensure patient comfort and allow same-day discharge. Patients can be discharged home after a minimum observation of 6h as this is the period with the greatest risk of primary haemorrhage. All patients must have a clear and safe understanding of which complications may occur and know how to seek help. A team effort and close collaboration between the anaesthetic, surgical, theatre and ward teams are essential to achieve optimum outcomes and reduce the rate of failed discharges.

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