DAY CASE SURGERY
‘One device’ approach to patient handling
The benefits of ambulatory surgery are well-documented, and there is increasing support for the ‘one-device’ approach for transport, treatment and recovery of day-case patients. Mark Lee discusses how this approach can help deliver efficiencies and improve safety for both staff and patients.
As far back as 2006, the case for surgical trolleys was made by the International Association for Ambulatory Surgery (IAAS). In its guidance, ‘Day Surgery Development and Practice’, it stated that:
“Hospital beds have no place in the management of true day surgery cases as they are cumbersome to move and, being wider, take up more space than trolleys. Equally, for the majority of surgical procedures, traditional operating tables should not be used. Modern comfortable operating trolleys combine the mobility of a trolley with all the attributes of an operating table…Trolleys have the advantage that patients are anaesthetised, operated on and recover on them. This reduces patient movement for the operating room staff and saves time.”1
The Association of Anaesthetists and the British Association of Day Surgery Guidelines for day-case surgery (2019) also advised: “The operating theatre and first-stage recovery areas should be equipped and staffed to the same standards as an inpatient facility, with the exception of the use of trolleys rather than beds. Several patients per day can occupy the same trolley space, providing a streamlined turnaround time.”2
Benefits of a ‘one device’ approach In some same-day surgery units / departments, which have not adopted this approach, staff can be using a combination of equipment for transfer, surgery and recovery including: lPatient transport stretcher (patient trolley) lOperating table lOphthalmology surgery trolley / chair lFluoroscopy / imaging trolley (e.g. for orthopaedics)
lShoulder arthroscopy trolley lSurgery / procedural stretcher (day surgery trolley)
Each of these represents not only an original purchase cost, but also maintenance and utility costs (if powered). Having fewer items of multi-functional equipment can offer cost- efficiencies, therefore.
A multi-functional device can also offer time efficiencies (as there is no need to swap equipment), and reduce storage space requirements, as well as contributing to a lower risk of manual handling injuries and hospital-acquired infection.
Although there is no direct evidence about the proportion of sickness absence linked to patient transfer or patient positioning, manual handling injuries linked to same-day surgery do occur, which means using any equipment designed to reduce manual handling offers significant benefits. In general, work-related musculoskeletal disorders costs the NHS £400 million each year and accounts for 40% of all sickness absences within the NHS.
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The changing demographic of the population also needs to be considered. The National Day Surgery Delivery Pack – co-produced by Getting It Right First Time (GIRFT) members, the British Association of Day Surgery (BADS) and the Centre for Perioperative Care (CPOC) – states: “While obesity is not a contraindication, theatre personnel should be aware of upper weight limits for trolleys in use. These should be suitable to manage patients across a wide weight range. If operating tables are moved between theatres for this purpose, trolleys are preferable to reduce manual handling risks for staff.”3
Infection prevention
According to NICE, healthcare-associated infections are estimated to cost the NHS approximately £1 billion a year, and £56 million of this is estimated to be incurred after patients are discharged from hospital.
AUGUST 2021
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