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

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.

Adult ENT day surgery: a case for expansion of services

2006 ◽  
Vol 88 (9) ◽  
pp. 314-317 ◽  
Author(s):  
MF Bhutta
Keyword(s):  
Day Surgery ◽  
Day Case ◽  
Day Case Surgery ◽  
The Past ◽  
Department Of Health ◽  
Audit Commission ◽  
Case Surgery ◽  
Commission Report ◽  
Gradual Expansion ◽  
The Uk

Day case surgery is acknowledged to have many advantages over inpatient surgery, including greater efficiency, reduced risk of infection, reduced waiting lists and lower costs. 1 Although in the past two decades day surgery has experienced a gradual expansion of services in the UK, the 2001 Audit Commission report on day surgery showed that there was still far more potential for expansion 2 and the Department of Health launched the 'day surgery strategy' in January 2002 with the specific aim of increasing and improving day surgery in the NHS.

Parental satisfaction with paediatric day-case ENT surgery

1999 ◽  
Vol 113 (12) ◽  
pp. 1072-1075 ◽  
Author(s):  
L. Hicklin ◽  
P. M. J. Tostevin ◽  
M. E. Wyatt
Keyword(s):  
General Practitioner ◽  
Specific Area ◽  
Day Surgery ◽  
Parental Satisfaction ◽  
Day Case ◽  
Audit Commission ◽  
Quality Of Patient Care ◽  
Degree Of Satisfaction ◽  
Case Surgery

AbstractDay surgery is increasing to improve the efficient use of NHS resources and it is vital that the quality of patient care is not compromised. The Audit Commission has recommended that there should be a systematic appraisal of the patient's views to monitor quality of day care. A survey of parental satisfaction with paediatric day-case surgery provides valuable information for those providing day surgery. A specific area of dissatisfaction previously identified is inadequate pain control following discharge. It is also suggested that day surgery may incur higher costs for the general practitioner.A retrospective study to investigate parental satisfaction with 100 paediatric otorhinolaryngology cases was performed. This study found 96 per cent of parents were happy with the treatment their child received, 89 per cent were satisfied with self-administered simple analgesia and no patients visited their general practitioner on the day following surgery. It is concluded that with careful selection and adequate support the degree of satisfaction with day surgery is high for a wide variety of procedures.

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.

Anaesthesia for Day Surgery

2007 ◽  
Vol 17 (7) ◽  
pp. 302-307 ◽  
Author(s):  
Kim Russon ◽  
Anthony Thomas
Keyword(s):  
Elective Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Preoperative Assessment ◽  
Day Surgery ◽  
Anaesthetic Technique ◽  
Day Case ◽  
Department Of Health ◽  
Common Causes ◽  
Good Pain Relief ◽  
Case Surgery

The Department of Health (DH) proposes that 75% of elective surgery should be performed as a day case procedure (NHS Plan 2000). To achieve this some modification of the traditional selection criteria may be required and careful thought given to the patient pathway, including the anaesthetic technique. Successful anaesthesia for day case surgery requires a balanced anaesthetic technique and multidisciplinary input which commences at booking, runs through preoperative assessment and continues to a nurse-led discharge. Suitable patients need to be selected (Digner 2007), prepared both physically and psychologically, undergo minimally invasive surgery with a suitable anaesthetic technique encompassing good pain relief and the avoidance of postoperative nausea and vomiting (PONV). Pain and PONV are the most common causes for a patient to require unplanned admission (Junger 2001).

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

scholarly journals Oral surgical procedures under local anaesthesia in day surgery

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Abdulkadir Burak Çankaya ◽  
Çağrı Akçay ◽  
Neşe Kahraman ◽  
Banu Gürkan Köseoğlu
Keyword(s):  
Surgical Procedures ◽  
Local Anaesthesia ◽  
Day Surgery ◽  
Oral Surgical Procedures

scholarly journals Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sara Campagna ◽  
Maria Delfina Antonielli D’Oulx ◽  
Rosetta Paradiso ◽  
Laura Perretta ◽  
Silvia Re Viglietti ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Surgical Procedures ◽  
Pain Therapy ◽  
Pain Treatment ◽  
Day Surgery ◽  
North West ◽  
Local Practices ◽  
Surgery Rates ◽  
A Prospective Study ◽  
Postoperative Pain Treatment

Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge.

Day-case anaesthesia in the elderly

2017 ◽  
Author(s):  
Chris Dodds ◽  
Chandra M. Kumar ◽  
Frédérique Servin
Keyword(s):  
Postoperative Cognitive Dysfunction ◽  
Postoperative Nausea And Vomiting ◽  
The Elderly ◽  
Day Surgery ◽  
Good Choice ◽  
Successful Outcome ◽  
Multimodal Approach ◽  
Day Case ◽  
Education Of Patients ◽  
Case Anaesthesia

Successful outcome from day surgery depends on good preoperative preparation, education of patients, day-surgery pathways, informed decisions regarding planned procedures, and postoperative care. Day surgery is widely accepted as the default position for the vast majority of patients requiring surgery, with inpatient stay chosen only by exclusion. Day surgery remains a good choice in the elderly, subject to appropriate home care after surgery. Patients should be assessed sufficiently ahead of the surgery to allow preparation, management of associated chronic diseases, and optimization. General anaesthesia may be associated with higher incidence of postoperative cognitive dysfunction, and it should be avoided as much as possible. Regional anaesthesia is the preferred choice when applicable because it provides good postoperative analgesia. Spinal anaesthesia is useful, but it can be associated with delayed discharge. A multimodal approach to pain relief and management of postoperative nausea and vomiting (PONV) are essential because inadequate management can significantly delay discharge.

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