Daycare Surgery + OT Setup + Hazard in OT 💸💵

Question 1

What is daycare surgery?

Answer 1

Hospital care which patient receives, who undergoes surgical procedures and is admitted to and discharged from the hospital within 24 hours of surgery

A.K.A Ambulatory surgery

Day care surgery is defined as scheduled surgical procedures provided to patients who do not
require hospital stay overnight. It is a process of care by which suitable patients are managed
with admission, treatment and discharge on the same day.

Question 2

What are the pre requisite of daycare surgery?

Answer 2

1. Hospital/ Facilities setting ( Hospital Factors)
   a. Dedicated day care surgery ward
   b. Dedicated or shared operating theater
   c. Recovery facilities
   d. Nurses and administrative personnel dedicated to the unit
   e. Contingency requirements for inpatient admission or readmission in cases of unexpeted complications or inadequate analgesia
2. Surgery ( Staff Factor)
   - Skilled surgeon
   - 90 min procedure
   - Total hours not > 6 hrs
   - Avoid surgery with high complication
   - Uncomplicated surgery which takes less than 90 minutes.
   - Procedures than have minimal risk of bleeding or other surgical complications.
   - Procedures that have minimal post op pain and need no special post op care.
   - Patient will not be immobilised in the post op period.
   - Procedure with no significant nausea and vomiting and patient can resume orally rapidly post op.
   - Minimal nursing care - not requiring special post op care
   - Minimal post op pain - Can take oral analgesic
   - Not requiring prolonged immobility
   - No blood tx
   - No drain

Anesthetist
- Familiar with day-care surgery: rapid clear headed emergence, minimal or no pain, minimal post-operative nausea or vomiting,
- No spinal anesthesia used

3. Selection of patients ( Patient’s Factor)
   - Patient
   
   • ASA 1 & 2
   • BMI < 35
     
     • BMI >30 kg/m2 Surgery might be more difficult, take longer and result in greater blood loss. Greater risk of airway problems, difficult tracheal intubation and longer recovery times.
   • Radius 20 km/1 hour from hosp
   • Phone availability
   • Has responsible adult
   • Age - Not extreme age (> 6 months and <70years old)
   • Comply to instruction
   • Need family support

Question 3

How to monitor daycare surgery success rate?

Answer 3

i. Cancellation rate
1. Due to failure to arrive
2. Cancellation after arrival: pre-existing medical conditions, acute medical conditions, organizational reasons

ii. Patient’s outcome
1. Outcome monitored
a. Unplanned return to operating room
b. Delayed patient discharge
c. Unplanned overnight admission
d. Readmission rate
e. Monitor morbidity and mortality
f. Patient’s functional health status and QOL assessment
i. Myles et al. developed a patient orientated quality of recovery score (QoR Score)
ii. Hogue et al. constructed the “24-hour functional ability questionnaire” to measure final recovery and satisfaction 24 h after surgery
g. Patients satisfaction

2. How to monitor
   a. Patient’s given contact numbers for day care unit and how to contact oncall surgeon
   b. Follow up in outpatient at POD1
   c. Patients were telephoned at POD5 and 14 by day care nursing staff and interviewed using standardized questionnaire
   d. Follow up appointment

iii. Economic outcome
1. Set up costs - area set up, new drugs, equipment and monitors required
2. Direct medical costs
3. Indirect costs that are supported by patient and family

Question 4

What are types of surgery that can be done under daycare surgery?

Answer 4

• GS- hernia, chemoport
• Urology – cystoscopy,IVU,BSO,ESWL,CE,
• Hepatobilliary – ERCP,lap cholecystectomy
• Peads – herniotomy, circumcision, orchidopexy
• Endoscopy upper/lower,EUS,ERUS

Question 5

What are the advantages of of daycare surgery?

Answer 5

• Can back to community
• Less waiting list
• Less disruption to work / family
• Less nosocomial infection
• Reduce cost
• Reduce incidence HAI/DVT
• Optimise OT list
• Reduce cancellation
• Better allocation of resources - Staff

Question 6

What are the disadvantages of daycare surgery?

Answer 6

• Less rapport
• less time for observation
• needing dedicated team
• Done by experience anest/ surgeon
• Man power
• Require adequate aftercare

Question 7

What are parameters suggesting suitability for day surgery?

Answer 7

• Minimal risk of postop haemorrhage
• Minimal risk of postop airway compromise
• Rapid return to normal fluid and food intake
• Postop pain controlled by outpatient mx techniques
• No special postop nursing requirement that cannot be met by the district nurse or specialist outreach nursing teams.

Question 8

What are criteria for patient to be discharge home?

Answer 8

• Observations within patient’s normal limits
• Pain controlled with oral analgesia
• Able to walk unaided (as preoperatively)
• Able to take fluids/solid food
• Passed clear urine (high-risk procedures/anaesthetic only)

Question 9

What advices should be given to patient during discharge?

Answer 9

• Should not drive within 24 hours
• No financial transaction
• No alcohol
• Advice admission if excessive pain, nausea, bleeding, vomiting, unable to PU, drowsiness, limb weakness
• Overnight home care
• Early access if EM - Phone, Transport

Question 10

Overview of OT Setup

Answer 10

Question 11

Hazard in OT

Answer 11