DAY CASE SURGERY
In addition to increased costs, each one of these infections means additional use of NHS resources, greater patient discomfort and a decrease in patient safety. A no- tolerance attitude is now prevalent in relation to avoidable healthcare-associated infections. Given that every medical device employed in the same-day surgical pathway carries a potential risk of infection or cross-infection, it follows that having as few devices/transfers as possible, minimises the risk. This will be particularly important as healthcare organisations strive to reduce the backlog of planned surgery caused by the pandemic.
Tackling the surgery backlog The challenge to reduce operation waiting times, even to pre-pandemic levels, cannot be underestimated, and the adoption of more same-day surgery is already being explored as part of the solution. Using one device for transport, treatment and recovery eliminates the need for transfers, offering time efficiencies and therefore helps to increase list capacity. A study published in The Orthopaedic Journal at Harvard Medical School in 2017 looked specifically at potential efficiencies of using surgical trolleys rather than operating tables for certain hand procedures. The study demonstrated that, through the use of a stretcher-based hand table, OR efficiency can be improved. Based on modelling, the study showed that this could return annual savings of $46,335 (approx. £33,763) per surgeon for isolated carpal tunnel and trigger finger releases. Additionally, the table made a favourable impression upon the OR staff, with “72% preferring the stretcher-based hand table and 100% thinking it improved efficiency.”4
Device design considerations At present, there is no accredited specification for these devices, either UK or internationally (e.g. BS EN ISO), so individual manufacturers have set their own parameters. However, the
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
key features of a device that can be deemed suitable for a one device approach to same- day surgery are as follows: Light weight: If the device is to be moved within a day unit / department or from one to an operating theatre, with a patient on board, it has to be designed to be as light as is feasibly possible to produce. Ideally, it will be light enough in itself to allow one member of staff to move it, with a patient onboard, so as not to become a drain on staffing resources or potentially cause a manual handling injury. Manoeuvrability: Being light in weight is one aspect, but there are other contributors to manoeuvrability: castors have to provide low rolling resistance, which can be down to diameter and design specification. The device can also have a steering function to aid transfer and provide an ergonomic pushing position. In the UK, the HSE states that push / pull forces in the workplace should not exceed 20kg of force to start motion and should not exceed 15kg while in motion. This is an important factor to consider when aiming to minimise manual handling injuries. Powered functions: To reduce the risk of manual handling injuries and provide even easier usage and safety for practitioner and patient alike, another beneficial option is powered functions (including but not limited to):
lPatient platform height lBack lift lTrendelenburg lReverse Trendelenburg lPatient platform longitudinal shift lLateral tilt
Low height: The patient platform, when at its minimum height setting, should be low enough to minimise the need for staff intervention when a patient is boarding and disembarking the device. This again minimises the risk of a manual handling injury and improves patient comfort and safety. Surgical versatility: To ensure the device meets the brief of a one-device approach, it has to be surgically versatile enough to be suitable for the full basket of procedures and to accommodate surgical preferences. Anaesthetic delivery: The device should
offer an articulating head section for cervical extension and rapid head down tilt through its Trendelenburg function as well as meeting all RCoA Guidelines for the Provision of Anaesthesia Service (GPAS) for Day Surgery 2021. Radiolucent: The patient platform needs to be radiolucent and its design must allow for full imaging device access. Tissue viability: Device mattresses must be to an appropriate specification to enable up to 23 hours of use to ensure tissue viability issues do not arise. Infection control: The device has to be quick, easy and convenient to clean. The design and materials employed should support this aspect. Price-sensitivity: Multiple devices will be required to accommodate scheduling in a same-day surgery department, so reasonable and justifiable pricing is essential. Reliability: Same-day surgery has to run as a lean equipping process to remain cost-effective, so any equipment downtime will have a negative impact on efficiency and productivity. The device has to be robust and reliable.
Integration into the surgical pathway In same-day surgery in the UK, patients will usually arrive on foot and the device may be used for the patient to be seated on while they await pre-operative assessment.
AUGUST 2021
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