Introduction
There has been a shift to perform more breast cancer surgery as day-case in recent years. Our unit has three pathways for breast surgery: the dedicated day surgery unit (DSU), an inpatient day-case list, and an overnight inpatient list. We observed a large proportion of day-case patients on the inpatient list were staying overnight, compared to those in the DSU. This is an audit to quantify the number of unplanned stays.
Methods
We retrospectively reviewed electronic patient records from September 2023 – July 2024 for patients booked on the inpatient day-case list.
Results
321 cases were planned as day-case on an inpatient list – 163 (51%) had an unplanned overnight stay. Of these, 81 (50%) had no formal documentation stating the reason for delayed discharge. 41 (25%) were booked as day-case despite being assessed as requiring an overnight stay at pre-op.
Comparatively 450 operations took place in DSU in the same period with just four overnight stays (1%).
Our day case average rate is 70% compared to the national standard of 79%.
Conclusion
High quality day-surgery is achieved by establishing good processes and monitoring outcomes for every stage of the patient journey. Pre-operatively counselling patients about the benefits of a same day discharge may discourage unplanned stays. Formal reporting of reasons for an unplanned stay is essential to making any improvement. At a cost of £527 per patient per 24-hour stay, improvement will result in a large financial benefit per year for our Trust.
Authors
Christina Gregory
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Ruth Parks
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Razia Bano
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Eleanor Gutteridge
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Hazem Khout
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Syeda Gilani
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom