Components of a successful model

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The high volume short stay (HVSS) surgery model is a surgical unit which includes the below features.

Patient

  • Consistent application of patient screening tools to identify suitable patients.
  • Defined patient inclusion and exclusion criteria.
  • Standardised protocols to streamline pre-admission assessments.
  • Defined patient education materials about hospital admission, preoperative preparation and readiness for discharge.

Process

  • Defined care pathways into and out of the service.
  • Protocols in place to communicate with primary and community care providers. These are available to staff and regularly reviewed. Protocols may include:
    • patient selection criteria and contraindications for HVSS surgery
    • clinical management pathways for high volume procedures
    • education and training for unit staff
    • patient transfer and handover
    • integration with outpatient services
    • quality and safety mechanisms.
  • A defined list of procedures deemed suitable for the model. Expected length of stay for suitable procedures is less than three days. These are based on local resources, demand and clinical expertise.
  • Consultant-led procedures, with trainees under the supervision of a consultant.
  • Processes in place for regular review of:
    • patient safety
    • care quality
    • operational efficiency
    • staff satisfaction measures.

System

  • Designated operating theatres and beds. Includes a minimum of two dedicated theatres supporting a minimum of six cases each per operating day.
  • Dedicated nursing and medical staff.
  • Separation of HVSS surgery and emergency surgery. This minimises disruption and maximises predictability.
  • Theatre lists are planned, based on procedure times. Patient admission times are staggered. Consider the variation in procedure completion rates between consultant-led and consultant-supervised lists.

References

  1. Ackerman IN, Berkovic D, Soh SE, et al. Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study. BMC Health Serv Res. 18 Dec 2023;23(1):1436. DOI: 10.1186/s12913-023-10427-5
  2. Barrie A, Hockings M, Isaac D, et al. Day case unicompartmental knee replacement: An update of the Torbay experience. Knee. Oct 2021;32:166-72. DOI: 10.1016/j.knee.2021.08.017
  3. Broe M, Carbin Joseph DD, Casson H, et al. Assessment of routine same-day discharge surgery for robot-assisted radical prostatectomy. World J Urol. Oct 2023;41(10):2679-84. DOI: 10.1007/s00345-023-04566-x
  4. Dreuning KMA, Derikx JPM, Ouali A, et al. One-Stop Surgery: An Innovation to Limit Hospital Visits in Children. Eur J Pediatr Surg. 2 Dec 2021. DOI: 10.1055/s-0041-1740158
  5. Furrer MA, Ahmad I, Noel J, et al. High-intensity theatre (HIT) lists to tackle the elective surgery backlog. Nat Rev Urol. Aug 2023;20(8):453-4. DOI: 10.1038/s41585-023-00775-6
  6. Getting It Right First Time. Surgical hubs. England, UK: NHS England; 2023 [cited 13 Feb 2024].
  7. Kleipool SC, van Rutte PWJ, Vogel M, et al. Feasibility of same-day discharge after laparoscopic sleeve gastrectomy in the Netherlands. Surgical Endoscopy. 2024;38(2):872-9. DOI: 10.1007/s00464-023-10590-0
  8. Wignadasan W, Thompson JW, Ibrahim M, et al. Day-case unicompartmental knee arthroplasty: a literature review and development of a novel hospital pathway. The Annals of The Royal College of Surgeons of England. 2021;104(3):165-73. DOI: 10.1308/rcsann.2021.0090
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