|Day Surgery Article|
|Publication Status||3b (Australian Surgeon Volume Winter 1998 vol 22 no 2 pp 24-25)|
|Copyright||Copyright of this article is vested in the author. Permissions for reprints or republications must be obtained in writing from the copyright holder. This article has been republished here with permission from the copyright holder.|
Recent Advances in Day Surgery
Lindsay Roberts, FRCS FRACS
Chairman, Australian Day Surgery Council, 1990 â€“ 2000
President Elect, International Association For Ambulatory Surgery 1999
“Many intermediate and some more major operations are suitable for day surgery but are still being treated for two or more days in acute bed hospitals, both public and private.”
Day surgery has expanded at an increasing rate, especially over the past five years. There are now 170 free standing day surgery/procedure centres in Australia and, in 1996-1997, a quarter of a million services were provided by these centres. With the progressing fall in private health insurance and increasing strain on the public hospital system, day surgery will continue to expand, as more and more patients are unable to afford private hospital treatment and public hospital waiting times (lists) continue to increase.
Over the past 21 months, the Australian Day Surgery Council has considered a number of fundamental day surgery principles which will have a significant influence on the further expansion of day surgery in Australia to reach its potential of 60 per cent, or even more, of operations/procedures, and each of these is unanimously supported by Council.
These principles are listed below.
- The Australian Day Surgery Council supports the concept of extended recovery, including overnight stay, in day surgery centres/units free standing and hospital based. (October 1996)
- Selected patients with acute surgical problems, including trauma, may be treated in day surgery centres, free standing or hospital based, provided there is no compromise to clinical administrative or discharge standards. (October, 1997)
- Council supports the development of free standing or hospital- based post-discharge convalescent accommodation for day surgery patients. (March, 1998)
- Council supports the concept of home nursing and other services which encourage day surgery for those patients who would otherwise require inpatient care, subject at all times to supervision by the treating clinician and consistent with best practice standards. (March, 1998)
Many intermediate and some more major operations are suitable for day surgery but are still being treated for two or more days in acute bed hospitals, both public and private. Surgeons frequently state that these patients require overnight nurse supervision before discharge, and this particularly applies to the more major operations. The concept of’ extended recovery, which includes overnight stay with nurse supervision, is an important development of day surgery services which will help to allay the concern of surgeons and ensure high quality of treatment for these patients.
Council considers that selected patients with acute surgical problems should be considered for treatment as day surgery patients and the provision of extended recovery services in day surgery centres/units will greatly facilitate the treatment of such patients, while maintaining high standards of treatment. The inclusion of such patients should be of great interest to public hospitals, which provide the great majority of accident and emergency services. It would help to relieve the pressure on acute beds if such patients were able to be treated in day surgery e.g. soft tissue and orthopaedic injuries.
Day surgery patients, by definition, complete their convalescence at home, however patients having intermediate and more major procedures would benefit from several days convalescence in appropriately designed and constructed surgical motels (step-down units, surgical villas -USA). These low bed cost convalescent motels could be developed in relation to both free standing and hospital based day surgery centres/units. The cost advantage of such units, both capital and ongoing, is obvious.
Following their discharge from day surgery centres or convalescent “motels”, same day patients may require home nursing and other services as determined by the treating clinician. These services are most likely to be required for those patients having intermediate and more major procedures, and it is essential that the same high standards of practice as provided by acute bed hospitals be available for these patients. The more minor procedures would require a minimum of post-discharge nursing services. It is essential that these home nursing and other services be available in both the private and public sectors, be supervised by the treating clinician and be cost efficient.
In summary, day surgery is well established in Australia and continues to expand, especially in the private sector. Although there are some excellent units in public hospitals, it is of concern that there has not been the same development and expansion of day surgery services in the public sector. Every public hospital should have a dedicated free functioning (preferably free standing) day surgery unit.