Conference highlights developments in implementation of day surgery
On Friday, 12 April, the Royal College of Surgeons in Ireland (RCSI) hosted a conference Maximising Day Surgery in Ireland for surgeons, nurses and healthcare administrators working in the area of day surgery. The conference heard from leading healthcare professionals involved in day surgery and highlighted the key developments and challenges facing its nationwide implementation.
Day surgery is the practice of admitting patients into hospitals on the day of surgery for a planned, non-emergency surgical procedure and discharging them within hours of their surgery. The conference heard that the shortfall in day surgery is the result of a combination of issues. Firstly, there is no clear classification on what constitutes a day surgery procedure. Another factor is the use of day surgery beds to accommodate in-patients, resulting in the cancellation of day cases.
Additional barriers to the provision of day surgery include the closing time of theatre, lack of community support, patient factors including age, knowledge, education and geographical location and the custom in hospitals of carrying out surgery as in-patients.
The first national survey of provision of day surgery in Ireland carried out by the RCSI Faculty of Nursing and Midwifery and reported in 2010 found that more than 60% of hospitals do not have dedicated day surgery units. Additionally, the range and number of pre-operative investigations were higher when the patient was seen by a registrar or SHO, rather than a consultant, regardless of the surgery being performed. Since that time there have been substantial improvements in the delivery of day surgery in Ireland, sponsored through the National Clinical Programme in Surgery which is a partnership between RCSI and the HSE.
Professor Seamus Cowman, Principal Investigator and Head of the School of Nursing, RCSI, said: "Day surgery is viewed as the optimal environment for many surgical procedures and with the advancement in surgical techniques which require less recovery time for patients and reconfiguration in the health care system, increasing emphasis has been placed on day case procedures. Our research has identified the barriers and has shown that important strides have been made to develop a process for day surgery to be implemented across all hospitals in Ireland."
The joint RCSI, HSE & ESRI study led by Professor Cowman, RCSI and funded by the HRB devised six statements of best practice for day surgery following a review of the day surgery process. These are patient information, pre-admission, documentation, management of day surgery, discharge protocols and monitoring of services. Evaluation of these six statements of best practice is currently being carried out in the clinical setting.
The conference heard from a variety of healthcare professionals that are involved in day surgery. Mr Mark Skues, from the British Association of Day Surgery gave the keynote address on Benchmarking in Day Surgery'. His lecture provided lessons and insights from the implementation of day surgery in England and Scotland. Professor Frank Keane, Joint National Clinical Lead in Surgery outlined the National Clinical Programme in Surgery and its role in day surgery. Dr Alan Smith, Special Delivery Unit in the HSE discussed ‘Change and the Challenge of Reform'. His lecture looked at the task of implementing reform and the challenges this can bring.
Professor Seamus Cowman, RCSI provided an update on the ‘Standards for Day Surgery in Ireland - HRB project'. Kieran Ryan, Irish College of General Practitioners outlined the impact of day surgery on primary care and general practice.