Delivering quality and value in surgery: The opportunities of day surgery and the short stay pathway

1
Delivering quality and value in surgery The
opportunities of day surgery and the short stay
pathway in a Rural General
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The change proposed in the Belford

• Create a dedicated 9 bedded Day Case Unit on the
  Surgical Ward
• Implement the Pre-assessment Service

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Why use day case and short stay surgery

• Best practice for surgery is to use day case as
  the default position for elective surgery to
  increase the quality and cost-effectiveness of
  surgical services and improve the patient
  experience of surgery
• In addition there are direct benefits of
  maximising the use of day case and short stay
  surgery to help the NHS meet the challenges it
  currently faces. It will
• Provide better services to patients
• Reduce costs and lengths of stay
• Help deliver waiting times targets

4
Providing better services for patients

• Speedier recovery for patients is promoted
• Patients have a preference to be treated on a day
  case basis with minimum disruption to their lives
• Patients are less likely to have their operations
  cancelled

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Helping deliver 18 week referral to treatment
pathways

• Greater use of day case and short stay surgery
  will help deliver this because
• Bed capacity becomes less of a constraint along
  the pathway and this will improve patient flow
  through the system
• Less operations will be cancelled due to bed
  availability
• It is more cost effective so we will be able to
  treat more patients within current resources
• It can dramatically reduce Referral to Treatment
  times when part of a transformed service e.g.
  Walk in walk out services which provide
  surgery under local anaesthetic on the same day
  as first OP. This reduces the need for
  pre-operative assessment and DNA rates and hence
  makes best use of capacity
• To get the full benefit of day case and short
  stay surgery we need to transform services e.g.
  new methods of pre-assessment
• Improvements in day case and short stay surgery
  rates needs to be part of planning for delivery
  of 18RRT

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Reducing costs lengths of stay Improving quality
and increasing activity

• Across NHS Highland progress in improving day
  case rates has been slow
• There is still a wide variation in day case rates
  by procedure across NHS Highland
• There is significant activity that the Belford
  could undertake to support Raigmore and NHS
  Highland achieve the 18 week referral to
  treatment target.

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What we need to do next

• Continue the change in mindset to treat day case
  and short stay surgery as the norm
• Initiate or maintain a day case strategy.
  Undertake a baseline diagnosis of day case
  potential Use the NHS Institutes Better Care
  Better value metrics
• Engage clinicians and managers in the change
• Set ambitious targets for day case performance by
  procedure
• Ensure day case surgery is being coded and
  reported correctly
• Implement standardised procedures for admission
  and discharge of day surgery patients
• Monitor unplanned overnight stays and act
• Commission appropriate surgical procedures on a
  day case basis
• Develop community support systems for patients
  leaving hospital in the evening