The home environment, distance from the hospital, parents’ (parent here and throughout this section refers to parent, guardian or carer) access to transport and a telephone, need to be considered. Tertiary paediatric centres are performing increasingly complex procedures as day cases. Screening questionnaires, in conjunction with agreed protocols, can offer guidance on appropriate pre‐operative investigations. These facilities may, or may not, be purpose‐built and the clinical lead must be aware of this in managing any risk. It is essential to inform the patient's general practitioner promptly of the type of anaesthetic given, the surgical procedure performed and the postoperative instructions given. Day case surgery is not a new concept. However, day case beds dispersed around many wards do not achieve the same efficiencies, nor do they provide the targeted service that is required to achieve good outcomes. The British Association of Day Surgery has produced a directory of procedures that provides targets for day surgery rates covering many different procedures 14. Generic information should include practical details about attending the day surgery unit, whereas procedure‐specific information should include clinical information about the patient's condition and the proposed surgical procedure. Currently, there is no set absolute minimum distance between any stand‐alone unit and the nearest Emergency Department, although long distances are rare. In this article, we shall look at patient selection for day case surgery, the types of procedures that are suitable, and how to prepare a patient as a surgical day case. Fasting times should be kept to a minimum. Day surgery in a local hospital is also possible for children with chronic stable disease provided the necessary expertise, infrastructure and support are in place. induction and which is most suitable for their child. Previous guidance was published by the Association of Anaesthetists in 2011 1. Annex B. The day surgery unit should have no capacity to accept overnight admissions. Consensus statement of a multidisciplinary working party. Technique and outcome of day case laparoscopic hiatus hernia surgery for small and large hernias: a five-year retrospective review from a high-volume UK centre. At a suitable time, they should change into theatre gowns and wait in a single sex area. This requires appropriate training and provision of senior cover, especially in stand‐alone units. The RCoA recommends that training in day surgery is delivered as part of core general duties and not only involves learning appropriate anaesthetic techniques, but encompasses the entire day surgery process. Day surgery is hence usually the optimal pathway for these patients and is associated with no increase in adverse outcomes when compared with the younger population. 100 CASES in Surgery James A Gossage MBBS BSc MRCS Specialist Registrar in General Surgery Bijan ModaraiMBBS BSc PhD MRCS Specialist Registrar in General Surgery Arun SahaiMBBS BSc MRCS Specialist Registrar in Urology Richard Worth MBBS BSc MRCS Orthopaedic Research Fellow Volume Editor: Kevin G BurnandMS FRCS Professor of Vascular Surgery, Academic Department of Surgery, … However, screening for hypertension 31, anaemia 32 and an initial risk assessment for venous thromboembolism 26 should be undertaken in order to guide management according to local protocols. The anaesthetic information leaflets developed jointly between the Association of Anaesthetists and the RCoA are a useful resource 37. Day surgery is a continually evolving specialty performed in a range of ways across different units. The BADS directory of procedures 14 includes a list of paediatric procedures although, as in adults, the range of procedures performed as day cases is constantly evolving. An analgesic plan for patients having spinal or regional anaesthesia is required, otherwise the patient may experience significant pain when the block wears off 50. Guideline on anaesthesia and sedation in breastfeeding women 2020. The clinical lead should be supported by a day surgery unit manager who has responsibility for the day‐to‐day running of the service. Many units favour multiskilled staff who have the knowledge and ability to work within several different areas of the day surgery unit. Initial advice should be given at pre‐anaesthetic assessment, with further specific information on the day of surgery. Effective pre‐anaesthetic assessment and preparation with protocol‐driven nurse‐led discharge are fundamental to safe and effective day surgery. Parental Experiences of the Pediatric Day Surgery Pathway and the Needs for A Digital Gaming Solution: A Qualitative Study (Preprint). Wherever possible, these instructions should be given in the presence of the responsible person who is to escort the patient home. However, it must be remembered that older patients are less likely to admit to feeling unwell, uncomfortable or distressed. In recent years, the complexity of procedures has increased with a wider range of patients now considered suitable for day surgery. In the UK, most hospitals follow local guidelines to aid in this – these generally include absolute and relative contraindications based on co-morbidities. Audit Scotland 2008. They should walk to theatre and ideally transfer themselves onto the operating trolley in the anaesthetic room. Most patients can be assessed and prepared for surgery in nurse‐run pre‐anaesthetic clinics. The RCoA's compendium of audit recipes devotes a section to possible audits relevant to day surgery 65. If inpatient surgery is being considered it is important to question whether any strategies could be employed to enable the patient to be treated as a day case. It is important to remember that high‐quality day surgery requires experienced senior anaesthetists and surgeons and that, although the day surgery unit is an ideal environment for training junior medical staff, relying on them to deliver the service results in poorer quality patient outcomes and reduced efficiency 71, 72. NG45, Elimination of preoperative testing in ambulatory surgery, The measurement of adult blood pressure and management of hypertension before elective surgery 2016, International consensus statement on the peri‐operative management of anaemia and iron deficiency, Introducing emergency surgery to the day case setting, Use of the day surgery unit for emergency surgical cases, Royal College of Anaesthetists and Association of Anaesthetists, You and Your Anaesthetic. It may not be possible or appropriate to centralise these services; however, all such patients should receive the same high standards of selection, preparation, peri‐operative care, discharge and follow‐up as those attending dedicated day surgery facilities. Association for Peri‐operative Practice. For advanced training, the greatest benefit will be gained from developing the trainees’ management and leadership skills in relation to the organisation of a day surgery unit. Further information on the use of spinal anaesthesia in day surgery and examples of patient information leaflets can be found on the BADS website (www.bads.co.uk). This may be affected by any supplementary local anaesthetic infiltration or regional anaesthesia used to provide longer acting anaesthesia at the operative site. Variations for specific groups, including children and patients undergoing procedures under local anaesthesia, should be available. A multidisciplinary visit to another unit where the procedure is performed successfully as a day case can be very helpful. For example, a patient who has undergone a hysterectomy as a day case is likely to require care to support activities of daily living for longer than someone who has undergone a hysteroscopy. (December 2019) (Learn how and when to remove this template message) Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery… The only patients routinely not included in day surgery are those with unstable medical conditions. In general, most medications may be continued up to the day of the operation, including the day of the procedure. Fitness for a procedure should relate to the patient's functional status as determined at pre‐anaesthetic assessment, and not by ASA physical status, age or body mass index 20-22. Prolonged deep vein thrombosis prophylaxis should be considered 26. Children with OSA presenting for tonsillectomy/adenoidectomy also need careful assessment. In the UK, most hospitals follow local guidelines to aid in this - these generally include absolute and relative contraindications based on co-morbidities. On discharge, all patients should receive verbal and written instructions and be warned of any symptoms that might be experienced. It has been endorsed by the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and the Royal College of Anaesthetists (RCoA). Wherever possible, children should be managed on dedicated lists separate from adults, or prioritised as a cohort to have their procedures at the start of the list and separated from adults in the recovery area and on the ward. Support from the community nursing team can be helpful, especially in the early stages. Retrospective single surgeon outcomes analysis during service relocation (inpatient to daycase) in a DGH. Patients and their carers should be provided with written information that includes warning signs of possible complications and when to seek help. Prevention of peri‐operative venous thromboembolism in paediatric patients, Royal College of Paediatrics and Child Health, Pre‐procedure pregnancy checking in under 16s: guidance for clinicians, Paediatric emergence delirium: a comprehensive review and interpretation of the literature, Consensus statement on clear fluids fasting for elective pediatric general anesthesia, Association of Paediatric Anaesthetists of Great Britain and Ireland, Guidelines on the prevention of post‐operative vomiting in children, Raising the Standard: A Compendium of Audit Recipes, CCT in Anaesthetics. 1963975 (England), © 2019 All rights reserved. It is important to evaluate the procedure while still performing it as an overnight stay in order to identify any steps in the process that require modification to enable it to be performed as a day case, for example, timing of postoperative X‐rays, modification of i.v.