Delivering quality and value in surgery: The opportunities of day surgery and the short stay pathway in a Rural General

1. Delivering quality and value in surgery: The opportunities of day surgery and the short stay pathway in a Rural General

2. The change proposed in the Belford Create a dedicated 9 bedded Day Case Unit on the Surgical Ward Implement the Pre-assessment Service

3. Why use day case and short stay surgery? Best practice for surgery is to use day case as the default position for elective surgery to increase the quality and cost-effectiveness of surgical services and improve the patient experience of surgery In addition, there are direct benefits of maximising the use of day case and short stay surgery to help the NHS meet the challenges it currently faces. It will: Provide better services to patients Reduce costs and lengths of stay Help deliver waiting times targets

4. Providing better services for patients Speedier recovery for patients is promoted Patients have a preference to be treated on a day case basis with minimum disruption to their lives Patients are less likely to have their operations cancelled

5. Helping deliver 18 week referral to treatment pathways Greater use of day case and short stay surgery will help deliver this because: Bed capacity becomes less of a constraint along the pathway and this will improve patient flow through the system Less operations will be cancelled due to bed availability It is more cost effective so we will be able to treat more patients within current resources It can dramatically reduce Referral to Treatment times when part of a transformed service, e.g. ‘Walk in, walk out’ services which provide surgery under local anaesthetic on the same day as first OP. This reduces the need for pre-operative assessment and DNA rates and hence makes best use of capacity To get the full benefit of day case and short stay surgery, we need to transform services, e.g. new methods of pre-assessment Improvements in day case and short stay surgery rates needs to be part of planning for delivery of 18RRT

6. Reducing costs, lengths of stay Improving quality and increasing activity Across NHS Highland progress in improving day case rates has been slow There is still a wide variation in day case rates by procedure across NHS Highland There is significant activity that the Belford could undertake to support Raigmore and NHS Highland achieve the 18 week referral to treatment target.

7. What we need to do next? Continue the change in mindset to treat day case and short stay surgery as the norm Initiate or maintain a day case strategy. Undertake a baseline diagnosis of day case potential – Use the NHS Institute’s “Better Care, Better value” metrics Engage clinicians and managers in the change Set ambitious targets for day case performance by procedure Ensure day case surgery is being coded and reported correctly Implement standardised procedures for admission and discharge of day surgery patients Monitor unplanned overnight stays and act Commission appropriate surgical procedures on a day case basis Develop community support systems for patients leaving hospital in the evening