However, when we looked at the information leaflets given to the patients before admission, we found that the written instructions did not correspond fully to the RCS guidelines.

Waiting times for procedures
The following diagram shows the waiting times for procedures in the hospitals during October 2001 (except for cataract extractions in LVH - the waiting times relate to March 2002).

Waiting times for Procedures by hospital

	Cystoscopy	Cataract extraction	Laparoscopic sterilisation	Vasectomy	Arthroscopy
Ulster & Ards	1 month	---	7 months	5.5 months	---
Belfast City	Varies	---	3-4 months*	over 2 years	---
Downe	2 months	---	2 months	2-6 weeks	---
Lagan Valley	8 weeks	12-18 months	3-4 weeks	3-4 weeks	---
Mater	4-5 months	5-9 months**	---	---	---
Musgrave Park	---	---	---	---	up to 2 years
Royal	up to 2 years	12 months	up to 14 months	up to 2 years	---

*Direct Referrals = 2 weeks **Urgent = 4-6 weeks
Ulster & Ards = average waits

c Arriving at hospital

Parking in hospitals
Most of the patients (78%) said it was easy to find parking spaces in the hospital grounds. However, over a fifth of the patients - especially in the Belfast City and Mater Hospitals - had difficulties finding parking spaces.

Signposting to day surgery units/wards
The patients were asked to rate the signposting in the hospital grounds that gave directions to the day surgery units or wards. Eighty-eight per-cent of the patients said the signposting was good or acceptable. Twelve per-cent of patients said the signposting in the hospital grounds was poor.

Most of the patients (94%) said it was very easy, or quite easy, to follow the signs inside the hospitals that gave directions to the day surgery units or the wards.

Facilities in day surgery units/wards
The Audit Commission (1990) stressed that a dedicated day surgery ward is the minimum requirement for efficient and effective day surgery. However, patients admitted for day surgery in Musgrave Park Hospital or the Royal Maternity Hospital were admitted to general wards - an arrangement which was not ideal for day surgery.

d Admission to day surgery units/wards

Waiting times in day surgery units/wards
Most of the patients (70%) waited five minutes or less, after arrival at the day surgery units/wards, before being admitted by the nursing staff.

Only a small number of patients (3) waited a few hours after admission before their surgery was carried out. This number was much lower than the percentage of patients in the UK- wide survey of day surgery (20%) who waited longer than three hours after arrival at the day surgery units before their operations were carried out (Which?, 1997).

Patient privacy and dignity
Most of the patients who had to undress for their procedures felt they had been given enough privacy when undressing (99%).

Thirteen per-cent of the patients who had been admitted to mixed-sex wards/units - especially in the Mater and Ulster and Ards Hospitals - had felt uncomfortable with the mixed-sex arrangements. A slightly higher proportion of women than men were dissatisfied with the mixed-sex arrangements (15% as opposed to 10%).

Care of patients'personal property
The information leaflets from most of the hospitals (except the Downe) which were given to patients before admission, stated that they should leave any valuables at home. Most of the patients (95%) were satisfied or very satisfied with where their belongings were kept while they were having their surgery.

e Before surgery

Information given to patients before surgery
Nearly all the patients (99%) felt they had been given as much information as they would have liked about the procedures before their surgery was carried out. The number of patients who felt they had not been given enough information (6) was much smaller than the proportion of patients in the English survey of day surgery (54%) who felt they had been given insufficient information before their surgery (Audit Commission, 1992).

Where the patients had concerns about the operations, most of them (98%) had been given an opportunity to discuss these concerns with the staff. Nearly all of these patients (99%) were satisfied or very satisfied with the explanations they were given.

Whether patients spoke to anaesthetists before surgery
The Royal College of Surgeons (1992) recommended that patients should be seen by an anaesthetist after admission and warned in advance about the side-effects of the anaesthetic - such as drowsiness, nausea, vomiting, dizziness and headaches. Where the patients had their procedures carried out under local anaesthetic, discussions with anaesthetists were not necessary. About half of the patients in this survey spoke to anaesthetists before their surgery. However, 7% of patients did not speak to any doctors before their surgery.

Type of anaesthetic given
The following diagram shows that the types of anaesthetic given before the procedures often varied within the hospitals and between different hospitals.

Type of anaesthetic given, by hospital and procedure

	Cystoscopy	Cataract extraction	Laparoscopic sterilisation	Vasectomy	Arthroscopy
Ulster & Ards	Local anaesthetic	---	General anaesthetic	Local anaesthetic	---
Belfast City	Local or General	---	General anaesthetic	Local or General	---
Downe	General anaesthetic	---	General anaesthetic	General anaesthetic	---
Lagan Valley	General anaesthetic	Local** anaesthetic	General anaesthetic	Local or General	---
Mater	Local anaesthetic	Local anaesthetic	---	---	---
Musgrave Park	---	---	---	---	General*** anaesthetic
Royal DPU	General anaesthetic	General anaesthetic	---	General (local*)	---
Royal OPU	---	Local anaesthetic	---	---	---
Royal Gynae	---	---	General anaesthetic	---	---

* Only one consultant carries out procedure under local anaesthetic.
** Cataract extractions were not being carried out in LVH at the time of the survey.
*** Occasionally, a spinal anaesthetic is given.

f Attitudes of staff

Friendliness of staff
Most of the patients said the receptionists and nurses in the day surgery units or wards were very friendly or quite friendly. However, a larger percentage of patients rated the nurses as very friendly, compared with the receptionists (98% as opposed to 86%).

General attitudes of staff
All the patients said the doctors/surgeons, nurses and anaesthetists (where applicable) had always been pleasant when they spoke to them.

Whether patients were treated with dignity and respect
Most of the patients (99.7%) felt the staff had treated them with dignity and respect at all times.

g After surgery

Feedback received after surgery
Most of the patients (92%) had been given feedback after their surgery. However, eight per-cent of patients - particularly those who had vasectomy or arthroscopy procedures carried out - had not received any feedback. The percentage of patients who did not receive any feedback after their operations was much lower in this study than in the UK-wide survey of day surgery (Which?, 1997) (8% as opposed to 40%).

Most of the patients who received feedback following their surgery were satisfied or very satisfied with the feedback they received (94%). Only 6% of.patients - especially those who had a laparoscopic sterilisation or a vasectomy carried out - were not satisfied with the feedback they had received after their operations.

Whether patients were given an opportunity to ask questions
Most of the patients (96%) had been given an opportunity to ask questions about what to expect when they were discharged home, for example, how much pain to expect. Only 5 % of patients said they had not been given an opportunity to ask questions (total is greater than 100%).

h Preparing for discharge from hospital

Assessment by staff before discharge
Most of the patients had their conditions assessed by the medical staff (81%) or nursing staff (95%) - or both - before they were discharged.

Whether patients felt well enough to go home
Most of the patients (96%) had felt well enough to go home when they were discharged. Only 5% of patients - mainly women - felt they could have waited longer before being discharged home (total is greater than 100%).

Checks made by staff before discharge
Most of the patients (96%) said the staff had made sure that they would be accompanied home by relatives or friends after their surgery.

Many of the patients (86%) said the staff had made sure that there would be relatives or friends staying with them for 24 hours after discharge. However. twelve per-cent of the patients said the staff had not made this check.

Whether patients were given written instructions on self-care
Most of the patients (82%) had been given written instructions on self-care after discharge, but almost a fifth of the patients (18%) had not received any written instructions. The percentage of patients who were discharged home without written instructions on self- care was much smaller in this survey than in the UK-wide survey of day surgery (I 8% as opposed to 56%) (Which?, 1997).

Whether patients were told who to contact if they experienced problems
Each hospital gave the patients written instructions on to contact if they experienced any problems after discharge. Most of the patients (96%) also said that the staff had advised them of what action they should take if they experienced any problems, for example, to contact the day surgery unit/ward, a GP or the Accident and Emergency Department.

i Recovery after day surgery

Pain experienced after day surgery
Over a quarter of the patients experienced no pain during the first 24 hours after surgery. However, 14% of patients - especially women who had laparoscopic sterilisations carried out - experienced a lot of pain during the 24 hours after surgery. Between four and seven days after the surgery, five per cent of patients were still experiencing a lot of pain.

Medical complications experienced
Five per-cent of the patients experienced medical complications after their surgery - including wound infections, bleeding and drug reactions. However, the proportion of patients in this study who experienced medical complications following surgery was smaller than the group of patients in the English survey who experienced unexpected medical problems in the month following their operations (5% as opposed to 8%) (Audit Commission, 1991).

j Satisfaction with day surgery

Satisfaction with treatment and care
Eight per cent of the patients made comments about the treatment and/or care which they had received in the hospitals, and these comments were generally positive (46 out of 56).

"...I was nervous about the operation and the nurse took great pains at putting me ease and reassured me. She also held my hand when I was given the injection into my eye..."

"Operation (was) very satisfactory and did not hurt"

"The staff talked me though the operation, this way relaxing and reassuring me. I was nervous but made very relaxed during the operation..."

The negative comments made by ten patients related to having to vacate their beds or be discharged when they still felt unwell; being discharged home unaccompanied (and with an intravenous cannula still in place); the degree of pain felt after surgery and/or the lack of painkillers provided, and day surgery being generally unsuitable because of anaesthetic problems.

"Although I was pleased with the overall experience. I did feel like I was slightly rushed to leave. I reacted very light-headed after the operation and felt like I probably should have been maybe admitted overnight to recover a bit better"

"I felt very uneasy about going home so soon afterwards as I was in an awful lot of pain. I feel very much that I was just thrown out of my bed, as it was needed for someone else"

Satisfaction with information and communication
Six per-cent of the patients made comments about the communication by staff and the information which they had received in relation to their day surgery, and most of these comments were positive (28 out of 40).

"(The) doctors and nurses were very helpful with questions when asked, and most reassuring at all stages of operation and post-operative care. I could have asked more questions had I had any questions about my condition, but time is required after the operation, to assess one's condition"

"I was informed step-by-step on how the procedure would be and what to expect"

The negative comments made by twelve patients related to general communication; patients not being given enough opportunity to discuss the procedures and/or anaesthetic before surgery; not being informed about the choice of anaesthetist before surgery; lack of privacy when the outcome of the surgery was being explained; receiving information after surgery while still sedated and being inadequately informed after surgery or before discharge.

"Had preliminary discussion with GP who told me there would be further discussion with doctor performing operation. The consultation covered details of operation but reasons for undergoing were not explored, as indicated by GP. Further consultation by GP or operation staff to identify motivations of patient and ramifications (would be) important as a screening process, to enable change of mind at an early stage" (vasectomy patient).

"I was very anxious about the cystoscopy and I would have liked more time to discuss my concerns with the doctor, and to discuss the possibility of a general anaesthetic"

Overall satisfaction with day surgery
Most of the patients (94%) were glad that they had undergone day surgery, rather than being admitted overnight. Only 4% of the patients would prefer to have stayed overnight in hospital after their surgery. The proportion of patients who would prefer to have stayed overnight in hospital after the surgery was smaller in this survey than in the UK-wide and Scottish surveys of day surgery (4% as opposed to 10% - 13%) (Which?, 1997, Bain et al, I 999).

Nine per-cent of the patients made comments expressing their satisfaction with the day surgery service received in the hospitals.

"Although initially apprehensive, I thought the whole procedure from start to finish was excellent and it suited me to use day surgery. This hospital is a great asset to us. All this is what the NHS is about. Top hospital and top staff"

"My experience of day surgery would incline my decision in the future to try it again if I had the choice"