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Done In A Day
1 Introduction
At least fifty per-cent of all planned surgery in the UK
is now carried out as day surgery (Which?, 1997). The growth
in day surgery has been influenced by:
- changes in medical practice, such
as encouraging patients to become mobile as soon
as possible after surgery;
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- advances in technology, for example,
the development of improved anaesthetic drugs and
analgesics and fibre-optics;
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- financial pressures to reduce
the numbers of in-patient beds; and
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- the development of minimal access
surgery
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(Audit Commission,
1990; Royal College of Surgeons, 1992).
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Guidance from the Royal College of Surgeons
(1992) stated that day surgery is appropriate for operations
which need a relatively short-acting general anaesthetic
(or a local or other type of anaesthetic) and, because they
do not carry a risk of complications after surgery, do not
require an overnight stay in hospital. In 1992, the Regional
Strategy for Health and Social Services stressed the need
for "a substantial shift" from inpatient to day care treatment.
The Department of Health and Social Services recommended
that up to 3,500 procedures which then involved staying
overnight in hospital could instead be carried out as day
surgery (DHSS, 1992: 20).
The benefits of day surgery for patients
are shorter waiting times, planned appointments and care
in dedicated facilities (Audit Commission, 1992), so there
is less disruption to the patients' home, working and social
lives (Moran et al, 1999). Day patients can also avoid the
risk of developing a hospital infection that can happen
when staying in hospital as an inpatient (Henwood, 1995).
However, day surgery patients may need more follow-up and
support in the community (Henwood, 1995).
The guidelines from the Royal College of
Surgeons stated that a patient's General health z@ status
and home circumstances should be taken into account when
deciding whether he/ she is suitable for day surgery. The
patient's housing conditions should allow the patient to
recover in comfort and there should be an inside toilet
and access to a phone. There should also be another responsible
adult available to provide care during the day and night
after discharge, and the patient's home should be no more
than an hour's journey by car from the hospital (RCS, 1992).
Given the large increase in the numbers
of patients who undergo operations by day surgery, the Eastern
Health and Social Services Board, the Department of General
Practice (Queen's University) and the Eastern Health and
Social Services Council agreed that a survey of patient
satisfaction with day surgery should be carried out, in
order to monitor the quality of day surgery services provided
by hospitals in the EHSSB area.
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