Major ear surgery in a paediatric day care unit

2002 ◽  
Vol 116 (10) ◽  
pp. 791-793 ◽  
Author(s):  
R. G. Rowlands ◽  
R. Harris ◽  
J. Hern ◽  
J. R. Knight
Keyword(s):  
Outcome Measure ◽  
Admission Rate ◽  
Day Surgery ◽  
Unplanned Admission ◽  
Day Case ◽  
Ear Surgery ◽  
The Usa ◽  
Unplanned Admissions ◽  
Mastoid Surgery ◽  
Case Basis

Abstract Traditionally major ear surgery in children has been regarded as an in-patient procedure. Evidence from the USA for adults, however, concludes that it is both safe and effective to perform many major ear procedures as day cases. We have been carrying out major ear operations on children as day cases routinely for six years in a dedicated children’s day unit and examined our data to find out whether it was both safe and feasible to perform major ear surgery in children on a day-case basis. As our main outcome measure we used the rate of unplanned admissions.We found that the unplanned admission rate for surgery, excluding mastoid surgery, was 6.7 per cent and that procedures such as myringoplasty, ossiculoplasty, bilateral pinnaplasty, meatoplasty and tympanotomy with excision of cholesteatoma, were eminently suitable for day surgery.

scholarly journals Ketorolac or Pethidine for Analgesia after Elective Laparoscopic Sterilization

1995 ◽  
Vol 23 (2) ◽  
pp. 158-161 ◽  
Author(s):  
L. Cade ◽  
P. Kakulas
Keyword(s):  
Admission Rate ◽  
Day Surgery ◽  
Double Blind Study ◽  
Unplanned Admission ◽  
Double Blind ◽  
Analgesic Effects ◽  
Recovery Times ◽  
Laparoscopic Sterilization ◽  
Unplanned Admissions ◽  
Intramuscular Ketorolac

Laparoscopic sterilization is commonly performed as a day surgery procedure despite difficulties in providing adequate postoperative analgesia for all patients. We have examined the analgesic utility of intramuscular ketorolac in this setting by comparing it with intramuscular pethidine, both given after induction in a randomized, double-blind study in sixty such patients. Although the analgesic effects of the two drugs were comparable in the immediate postoperative period, ketorolac provided significantly better analgesia four hours after surgery (pain score of 2.7 v. 4.2, P=0.006). The recovery times taken to awake, to ambulate and for discharge were all significantly shorter after ketorolac (4.6 v. 8.8 min, P=0.01; 178 v. 260 min, P=0.0005; 242 v. 320 min, P=0.02), and the unplanned admission rate was also significantly less after ketorolac (7% v. 33%, P=0.01). Ketorolac appears to be a useful supplement for analgesia after laparoscopic sterilization, providing improved analgesia as well as decreased recovery time and fewer unplanned admissions.

A comparative study of patient satisfaction with day case and in-patient major ear surgery

2006 ◽  
Vol 120 (8) ◽  
pp. 670-675 ◽  
Author(s):  
J R Tysome ◽  
N D Padgham
Keyword(s):  
Patient Satisfaction ◽  
Response Rate ◽  
Day Surgery ◽  
Postal Questionnaire ◽  
Day Case ◽  
Cross Sectional Survey ◽  
Ear Surgery ◽  
Cross Sectional ◽  
Level Of Satisfaction ◽  
Case Basis

Introduction: Major ear surgery can be safely performed on a day case basis (i.e. six hour stay). This study aimed to ascertain whether patients had the same level of satisfaction and speed of recovery following major ear surgery when it was performed as a day case compared with performance as an in-patient procedure.Method: A cross-sectional survey, by postal questionnaire, of patient satisfaction with day case and in-patient major ear surgery was carried out with 158 patients. Comparisons were made between the responses of the two groups.Results: The response rate was 71 per cent. Patients returned to work significantly sooner following day surgery (p < 0.025) but felt their operation to be of significantly more benefit following in-patient surgery (p < 0.05).Conclusions: Patient satisfaction following day case major ear surgery is as good as that following in-patient surgery. This has supported the expansion of this service in our unit.

scholarly journals Day-Case Rigid and Flexible Ureteroscopy

2007 ◽  
Vol 89 (5) ◽  
pp. 526-528 ◽  
Author(s):  
EJ Bromwich ◽  
R Lockyer ◽  
SR Keoghane
Keyword(s):  
Clearance Rate ◽  
Admission Rate ◽  
Day Surgery ◽  
Prophylactic Antibiotics ◽  
Flexible Ureteroscopy ◽  
Safe Procedure ◽  
Unplanned Admission ◽  
Day Case ◽  
Stone Clearance ◽  
Inflammatory Drugs

INTRODUCTION The aim of this study was to evaluate the feasibility of rigid and flexible ureteroscopy as a day-surgery procedure. PATIENTS AND METHODS All patients requiring elective ureteroscopy from March 2004 were considered for a day-surgery procedure. The standard day-surgery exclusions existed but there were no urological criteria for exclusion. A single consultant urologist performed or supervised all procedures. RESULTS A total of 64 patients underwent 50 rigid and 14 flexible procedures. Six diagnostic ureteroscopies were performed. There was a 96% stone clearance rate. Five patients required an unplanned admission within the first 2 weeks' postoperatively. Three of these patients were admitted on the day of surgery, two for pain and one for social reasons. Two patients were admitted at 24 h and 48 h, respectively, for urinary retention. CONCLUSIONS Ureteroscopy, both rigid and flexible, is a safe procedure for the day-surgery setting. Routine use of prophylactic antibiotics, intravenous non-steroidal anti-inflammatory drugs resulted in an acceptable re-admission rate.

Relocation experiences with unplanned admission to a nursing home: a qualitative study

2016 ◽  
Vol 29 (3) ◽  
pp. 517-527 ◽  
Author(s):  
Andrea Luise Koppitz ◽  
Jutta Dreizler ◽  
Jeanine Altherr ◽  
Georg Bosshard ◽  
Rahel Naef ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hospital Discharge ◽  
Qualitative Content Analysis ◽  
Secondary Data ◽  
Unplanned Admission ◽  
Convenience Sample ◽  
Face To Face ◽  
The Usa ◽  
Unplanned Admissions

ABSTRACTBackground:In many countries, people over 85 years of age are relocated involuntarily or unplanned to a nursing home. In Switzerland, 43% of elderly over 85 years are admitted to nursing homes after hospital discharge. This percentage is higher than in the USA with 32.5% or in Germany with only 19%. Despite those more frequent Swiss admissions, no research has been conducted exploring how unplanned admissions to nursing homes affect the adaptation. Therefore, the aim of this study was to gain an in-depth understanding into unplanned admissions to nursing homes and to explore its impact on adaptation.Methods:The study used a qualitative interview design based on Meleis’ transition model. Secondary data analysis was guided by Mayring's qualitative content analysis. Face-to-face interviews with elderly over 77 years (n= 31) were conducted from a convenience sample in Switzerland between January and March 2013.Results:The following four patterns of adaptation emerged from the analysis: “being cut-off,” “being restricted,” “being cared for,” and “moving on.” The patterns evaluate the relocation into nursing homes and provide an opportunity to appraise the stages of adaption.Conclusions:This study presents a model of analysis to evaluate patterns of adaptation following an unplanned admission to a nursing home after hospital discharge.

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.

Role of a home care team in paediatric day-case tonsillectomy

2001 ◽  
Vol 115 (1) ◽  
pp. 39-43 ◽  
Author(s):  
C. Shah ◽  
R. Shahab ◽  
P. Robb ◽  
D. Roy
Keyword(s):  
Home Care ◽  
Admission Rate ◽  
Care Team ◽  
High Morbidity ◽  
Unplanned Admission ◽  
Day Case ◽  
Case Rate ◽  
Telephone Calls ◽  
Haemorrhage Rate

The feasibility of paediatric day-case tonsillectomy (PDCT) depends on its safety and acceptance by parents and patients. The purpose of our retrospective study of paediatric day-case tonsillectomy was to review the role of the home care team (HCT) in improving the safety and acceptance of the procedure.Between January 1997 and June 1999, 352 consecutive children underwent day-case tonsillectomy. The notes and HCT assessment sheets were reviewed for telephone calls made by HCT or by parents, home visit by HCT, types of complication and their outcome.The primary haemorrhage rate was 0.6 per cent. The effective day-case rate was 97 per cent. The unplanned admission rate was three per cent. The HCT visited about 25 per cent of patients at home. We conclude that paediatric day-case tonsillectomy is associated with high morbidity and considerable parental anxiety that can be dealt with by timely reassurance, support and advice by a dedicated HCT.

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.

A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision

2018 ◽  
Vol 28 (10) ◽  
pp. 924-929 ◽  
Author(s):  
David Joel Stoeter ◽  
Stephen Roberts
Keyword(s):  
Admission Rate ◽  
Care Bundle ◽  
Unplanned Admission ◽  
Day Case

Day surgery

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Patient Selection ◽  
Organizational Factors ◽  
Day Surgery ◽  
Diabetic Patients ◽  
Day Case ◽  
Neuraxial Blockade ◽  
Staffing Levels ◽  
Patient Pathways ◽  
Case Basis

This chapter describes the organizational factors necessary for the provision of a day surgery service; ideal layout of units, staffing levels and patient pathways. Guidelines for provision of day surgery regarding patient selection, recovery and nurse-led discharge are included from the AAGBI and BADS. Day surgery advances mean that patients having regional and central neuraxial blockade, as well as diabetic patients requiring insulin, can now successfully be managed on a day case basis.

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