Done In A Day

2 Survey Design

A steering group - consisting of representatives from the Department of General Practice (Queen's University), the Eastern Health and Social Services Board and the Eastern Health and Social Services Council - was set up to advise on the design of the survey. The steering group decided that the survey would focus on adult patients only (aged 16 or over) and include the seven acute hospitals in the EHSSB area:

Ulster and Ards Hospitals
Belfast City Hospital
Downe Hospital
Lagan Valley Hospital
Mater Hospital
Musgrave Park Hospital
Royal Group of Hospitals

(Day Procedure Units - DPUS; Ophthalmic Day Unit - ODU)

Day surgery patients were admitted to dedicated day surgery units in the Mater, Belfast City, Lagan Valley and Downe Hospitals. Although patients for day surgery were usually admitted to a dedicated day surgery unit in the Ards Hospital. a very small number of patients were also admitted to wards in the Ulster Hospital. Most day surgery patients in the Royal Hospital were admitted to Day Procedure Units, but women who had gynaecological surgery carried out were admitted to a ward in the Royal Maternity Hospital. Patients admitted for day surgery in Musgrave Park Hospital were admitted to an orthopaedic ward.

Only the Lagan Valley Hospital had a purpose-built day procedure unit - day surgery was carried out in converted wards in the other hospitals. At the time the survey was taking place, day surgery in the Mater Hospital was also carried out in a converted ward. However, a day surgery unit has been purpose-built in the meantime, and this should be kept in mind when reading the results relating to facilities in the Mater Hospital.

It was agreed that the survey would focus on five types of day procedures - cystoscopy, cataract extraction, arthroscopy, laparoscopic sterilisation and vasectomy. Although seven hospitals were included in the survey, not all of the procedures are carried out in each hospital.

In particular, sterilisation and vasectomy procedures are not carried out in the Mater Hospital and only arthroscopy procedures are carried out in Musgrave Park Hospital. Cataract procedures have only been carried out in the Lagan Valley Hospital since late 200 1, after the survey was finished. Although laparoscopic sterilisations are routinely carried out in the Downe Hospital, we did not receive any questionnaires from women who had this procedure carried out in the Downe Hospital.

The survey looked at patient satisfaction with day surgery - before and after admission to hospital; before and after surgery and after discharge from hospital. The patients were given questionnaires which consisted of two parts. Part One was filled in by the patients while they were still in hospital, and Part Two was filled in after discharge - about a week after the surgery.

We asked the nurses in the hospitals to give a questionnaire to each patient who had one of the five procedures carried out between 2nd April and 22nd June 2001 - about 2260 patients in total. A member of staff from the EHSSC was available to help the patients fill in the questionnaires, if needed. This member of staff also spent five weeks in the Royal Victoria Hospital giving out questionnaires to patients who had cataract extractions and helping them to fill in the questionnaires.

There were no patient details made available to the EHSSC. We provided freepost envelopes (marked confidential) to the patients, so they could return their questionnaires to the EHSSC. The hospital staff did not see the filled-in questionnaires, except where the patients had asked for their help in filling in the questionnaires. The total number of filled-in questionnaires we received was 682 - that was a low response rate of 30%. We were only able to compare the results for particular procedures for 642 patients, as forty patients did not state what operations they had carried out.

The Chief Officer and Research Officer from the EHSSC also visited the Day Procedures Units and wards, in order to look at the layout of the units and the facilities that were provided. We found out how day surgery was organised and got information on the care given to patients before and after surgery and before their discharge from hospital. We also got copies of the information leaflets that the patients are given before admission, or during their stay in hospital, and any forms that the patients are asked to fill in before admission.

We analysed responses to the questionnaires according to the hospital and the type of procedure, and compared the hospitals which carried out the same procedures. We looked at the information leaflets and forms provided by the hospitals, to see how they made sure the patients were suitable for day surgery and the instructions which they gave for care after discharge. We checked whether the written instructions given to patients corresponded to the guidelines from the Royal College of Surgeons (1992). We also asked the patients for their comments on day surgery, and a selection of their comments are included in the report.

Where appropriate, we also compared our survey results with the results from other surveys of patient satisfaction with day surgery, which had previously been carried out in England, Scotland and UK-wide.