1. OVERNIGHT STAY OF DAY SURGERY PATIENTS IN WRIGHTINGTON
Mr Michael Walton
Mr Jeremy Oakley
Dr Raviprasad.Kattimani
Dr Chetan Dojode

2. Aim of the Audit
To address reasons for overnight stay in Wrightington after day surgery

3. Day Surgery
Day surgery is best defined as “the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day. True day surgery patients, are day case patients who require full operating theatre facilities and/or a general anaesthetic, and any day cases not included as outpatient or endoscopy”.

4. Benefits to patients
Patients receive treatment that is suited to their needs and which allows them to recover in their own home.
Cancellation of surgery due to emergency pressures in a dedicated day surgery unit is unlikely.
The risk of hospital acquired infection is reduced.

5. Benefits to hospital
Clinicians can provide high quality care for appropriate patients, and release inpatient beds for more major cases.
Trusts can reduce waiting lists.
Primary Care Trusts (PCTs) can commission cost-effective healthcare.

6. Methodology
Data collected from 6th of August 2012 to 21st of February 2013 ( 7 months ).
Inclusion :- Arthroscopic knee and shoulder cases.
Exclusion :- Foot and Ankle, Hand surgery .
Retrospective, EPR and clinical notes reviewed.

7. Results Data Number Total procedures of day cases 689 Over night stay
104 (15%)
Average age
51.84 years
Case notes obtained 79

8. Procedures Procedure Number Percentage Subacromial decompression 20
25.3 %
Rotator cuff repair 15
18.9 %
Diagnostic knee arthroscopy 3
3.7%
Diagnostic shoulder arthroscopy 1
1.2%
SLAP repair 5
6.3%
MPFL reconstruction 2
2.5%
Meniscectomy 23
30 %
ACL reconstruction 8
10.1%
Meniscus repair

9. Procedures

10. Reasons for stay 40.5% 33 7.5% 6 5% 4 20.25% 16 2.5% 2 8.8% 8 Reasons
Percentage
Number
ANAESTHESIA
40.5% 33
MEDICAL
7.5% 6
SURGICAL 5% 4
SOCIAL
PHYSIOTHERAPY
20.25% 16
MISCELLANEOUS
2.5% 2
NO REASONS FOUND
PAIN RELIEF
8.8% 8
LATE THEATRE

11. Anesthesia related (n=32)
Reasons
Number
percentage
Nausea and vomiting 9
28.1
Giddiness 6
18.7
Post op retention
Respiratory problems 3
9.3
Low oxygen saturation 4
11.2
Hypothermia 2
Tingling and numbness
Block related 1
3.1

12. Anesthesia Type of Anesthesia GA Spinal 73 (91.1%) 6(7.9%) ASA GRADE 126 2 41 3 12

13. Medical reasons Reasons Number Asthma 1 Pulmonary embolism DVT
High blood sugar
Chest pain 2

14. Days of stay Number of days Patients Percentage 1 day 71 89.8% 2 days4 5%
3 days 2
2.5%
4 days

15. Recommendations
Anaesthetist need to look whether there are any recurring anaesthetic technique/drug issues which results in nausea, vomiting or giddiness.
Guidelines for eligibility criteria for Day cases.
Provision of Physiotherapy on same day.
To exclude patients with multiple medical co morbidities.
Re audit in 6 months.

16. THANK YOU