Factors influencing success

Consider each of the following components when setting up a high volume short stay (HVSS) surgical unit.

Patient-centred care

In a HVSS surgery model, open communication is key to delivering patient-centred care. This helps patients, families and carers to:

• understand the planned care journey
• know what to expect from their hospital admission
• have the opportunity to ask questions
• be involved in care decisions.

The result is that services can be better coordinated, there is less duplication and fewer unexpected issues. Resources are used more effectively and patients are better prepared for their procedure. This improves staff experience in delivering care as well as patient experiences of receiving care.

Workforce

HVSS units with dedicated staff matched to the demands and scope of the service report:

• increased predictability and efficiency of internal workflows
• improved staff satisfaction
• a greater sense of belonging among team members.

The workforce model of the unit should incorporate:

• an identified clinical director and nurse manager
• experienced surgical staff, with advanced procedural skills
• nursing staff with suitable skills and experience to lead pre-operative patient assessments
• dedicated anaesthetists for review of complex or high-risk patients
• dedicated administrative support staff to manage bookings and scheduling of theatre lists.

Further detail around the skills and function of staff roles is in the roles and responsibilities section.

For efficient service delivery:

• have rosters that include time to prepare patients and theatres before planned start time of the theatre list
• ensure staff are familiar with expected patient flow from admission through to discharge
• give nursing staff working in HVSS units a high degree of autonomy and patient contact. They are responsible for pre-admission assessments, post-operative care and discharge.
• put systems in place for professional development. This includes training, skill development and education.

Infrastructure

The layout of the HVSS unit supports a seamless patient journey. If possible, locate the HVSS unit close to the operating theatre suite. Have strong communication links with pre-admission clinics.

Features of the unit to improve functionality include:

• a reception area and waiting room, for patients to complete documentation at the point of admission
• space for patient assessment and preparation prior to surgery
• layout to facilitate easy observation of patients to allow post-operative streaming of day-stay and overnight patients
• recovery beds and bathroom facilities
• suitable area for patients requiring isolation
• appropriate storage areas for sterile and non-sterile supplies
• staff facilities, including dedicated spaces for the director and nurse unit manager, staff education and break areas
• patients requiring overnight beds may be accommodated in designated HVSS ward facilities or in wards integrated with the broader surgical service.

The organisational models section describes the three models for HVSS units.

To support patients who become unwell and require a higher level of care, establish relationships with support services such as:

• critical care
• imaging
• pathology.

Protocols

Protocols help reduce variation in clinical practice. They:

• promote teamwork across clinical disciplines
• increase consistency of service delivery
• improve staff confidence when making clinical decisions (particularly in services with a high rotation of trainees and registrars).

Develop evidence-based protocols in collaboration with the multidisciplinary team. Make them accessible and routinely evaluate compliance, appropriateness and patient outcomes. They should not replace clinician-led care.

Establish protocols for the pre-, intra- and post-operative elements of each procedure that is in scope for the unit.

This may include:

• protocols for all patient groups, such as pre-admission assessment
• procedure-specific protocols, such as clinical pathways and criteria for discharge
• protocols for managing patients who deteriorate and require higher levels of care.

Build flexibility into protocols. Support tailoring to local context and individual patient need.

References