Day surgery
Surgery Nurse Manager, is essential to allow development of these skills. A good Nurse Manager can drive efficiency and training of staff to get the best results. Unless the Nurse Manager has day surgery experience and is supported in their efforts to manage effective unit staffing and training, it can be difficult to run an efficient day-to-day service.
Minimising unplanned admission There is always the possibility of a surgical or anaesthetic complication that warrants admission or unexpected perioperative issues preventing discharge. The concept of a standardised day surgery pathway, with individualised pathways for specific procedures embedded within it, serves to maximise successful day surgery by promoting best practice, minimising unwarranted variation and ensuring a consistent message is perceived by the patient at all points in the journey. Pathways should include the stages already discussed – from pre-op planning through admission, perioperative care, surgical technique, analgesia and nausea prevention, nurse-led discharge and follow-up. In adherence to consistent practice and pre- emptive planning for more complex cases, the likelihood of unplanned admission is reduced to that which is truly unexpected. Many different types of day surgery units exist and not every hospital has the ideal isolated day surgery unit with its own operating theatre, dedicated admission and discharge wards and staff. Where pathways have to use a mixed inpatient ward or main theatres, this can act as a barrier to successful same day discharge. Research shows that day surgery rates
decrease if these patients are on mixed wards post-operatively where they may get less attention that other more major surgery patients and thus not receive the early mobilisation and support needed to get them home. It may seem easier or kinder to nursing staff to let them stay in overnight. Also lack of experience in seeing more elderly or frail patients going home the same day can be a negative factor. Conversely, the concept of a remote site
or isolated day surgery unit can be perceived as a barrier to introducing more complex cases with a potential higher proportion of cases failing to achieve same day discharge. Ultimately, in these cases, local decision making based on service provision available and risk assessment is key. The involvement of the multidisciplinary team in building a robust pathway that includes management
Löwenstein Medical UK Ltd, I E-Centre, Easthampstead Road, Bracknell RG12 1NF
t: 01344 830023 e:
info@loewensteinmedical.co.uk w:
loewensteinmedical.co.uk
July 2024 I
www.clinicalservicesjournal.com 35
and transfer in the event of admission being required can help alleviate anxiety. A 24-hour follow-up telephone call for
day surgery patients serves to ensure early detection of complications, promotes patient education and can alleviate anxieties. It often falls within the remit of the ward nursing staff who have knowledge of post-operative surgical and anaesthetic complications and their management. It is important in helping to avoid patient readmission and may prevent post- operative healthcare contact needs becoming a barrier to ongoing successful day surgery.
Widening surgical variety The idea that only simple procedures are done as day surgery can also be a large barrier. It may not be believed that larger or more complex procedures can be done at all in day surgery,
so there is no impetus to try. Organisations such as BADS can help with networking and provide examples of successful pathways through educational events and literature. Demonstration of success in one unit can motivate change in others, promote shared learning from good examples and highlight pitfalls to avoid. The Getting It Right First Time (GIRFT) project also provides examples of high quality daycase pathways and provides frameworks for units considering change. New procedures previously done with an inpatient stay can be moved into the day surgery arena if surgeons and anaesthetists are enthusiastic about doing this. The whole team should be part of pathway development to achieve success including management staff, clinicians, nurses, theatre staff, allied healthcare professionals, pharmacists and administrative
breathe difference
loewensteinmedical.com
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
