September 13 2017
An article by the team on their work was also published in the British Journal of One Day Surgery (BJDS), a prestigious journal that covers advances in day surgery. The presentation and article examined how the team worked to meet the challenges of the Association’s guidance on reducing the number of keyhole gall bladder removals resulting in unnecessary overnight hospital stays.
BADS, which sets the clinical gold standard for day procedures, advises that more than 60 per cent of elective gallbladder removals by keyhole surgery (laparoscopic cholecystectomy) can be performed as day case surgery.
In 2010, only 14 per cent of this type of surgery carried out at the centre were day cases, while the remaining 86 per cent required overnight stays. Consultant anaesthetist Medhat Hashem explained: “Some cases do require an overnight stay, but for those patients who have no medical reasons or social care reasons to remain with us there are significant benefits to going home on the same day.
“The risk of developing infection and deep vein thrombosis are greatly reduced if patients are up on their feet and moving around. People also feel more relaxed and recuperate better at home.
“A greater proportion of day patients also ensures that beds are available and so can increase the number of patients who can be treated.”
The team were able to increase the number of day cases by multi-disciplinary working. Dr Hashem said: “Our administrative and clinical teams worked together to ensure those people who would need to have overnight stays, because of other medical conditions or because they had no one to return to at home, were put on a list for overnight cases. We could then schedule our day cases early in the day.
“In the operating theatre, before starting the procedure, the site of the surgical cut and the abdomen are treated with local anaesthetics. The anaesthetic protocol also includes a combination of drugs to prevent the pain and post-operative nausea and vomiting.” Surgeons also refrained from inserting drains.
The changes have been successful, bringing the rate to the 60 per cent recommended by BADS in just one year. The improvement continues to progress on a yearly basis, to reach 86 per cent in 2016. The team believe this is due to the slow but inexorable cultural change throughout all staff who now believe that laparoscopic cholecystectomy should be performed as a day case.
Dr Hashem said: “The culture changed from ‘can be’ to ‘should be’ as all staff see the benefits to their patients. Our teams have worked hard and well to meet the targets and improve the service patients receive. We were all delighted when we were asked to present our methods of working to our colleagues nationally so that other NHS patients can benefit from our work.”