Date of Award
MD (Medical Doctor)
Professor Seamus Cowman
Mr Eadhbhard Mulligan
Ambulatory Surgical Procedures, Ireland
Recent reports have suggested that day case rates vary significantly across Irish hospitals. Aim: To gain an understanding of the structures and processes which currently facilitate or constrain optimisation of day surgery in Ireland and development of recommendations for future practice including how barriers may be overcome.
Method: A two stage study was undertaken. The first stage aimed to develop an understanding of current day surgery practices. A national survey of private and public hospitals day surgery activity in Ireland was undertaken. This was followed by an in-depth chart review of 200 patient charts from two Irish teaching hospitals to outline current practices in elective surgical services. The second stage built on the first stage and aimed to develop statements of best practice for day surgery. A three round electronic Delphi process (eDelphi) aimed towards gaining consensus among experts in the field was undertaken.
Results: The national survey demonstrated a wide range of practices in hospitals across the country. The single most important barrier to increased day surgery identified by respondents was custom and practices and a lack of pre-assessment. Through the chart review the lack of pre-assessment and its effects on the day surgery process were confirmed, as well as other reversible barriers. Using the eDelphi process, consensus was achieved on 40 statements of best practice covering the following areas: patient information, pre-admission/pre-assessment, documentation, management of day surgery, discharge protocols and monitoring of services.
Conclusion: The study is the first of its type in Ireland and has provided clarity on current day surgical practices. There is considerable variation in day surgery practices across Irish hospitals. Statements of best practice based on consensus of experts working in these services were developed and will support a national change in day surgery practices.
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Meshkat B. Day Surgery in Ireland: current barriers and determining a consensus driven best practice approach. [MD Thesis]. Dublin: Royal College of Surgeons in Ireland; 2012.