Masha Zdravkovic
Athanasius Ishak, Masa Zdravkovic, Oliver Curwen, Nikolaos-Andreas Anastasopoulos, Paul Dent
Croydon University Hospital, London, United Kingdom
Abstract
Introduction:
Day case hernia surgery is an established standard of care across the UK. It is safe, cost-effective, and has been shown to improve patients’ healthcare experience.
Methods:
Patients were retrospectively identified from an electronic database. All patients who had an open repair for a primary inguinal or umbilical hernia planned as a day case procedure were included.
Results:
372 patients (266 inguinal and 106 umbilical) were included over a 1-year period. The first cycle of data collection revealed that 17% of patient discharges were delayed with the commonest reason being urinary retention, accounting for 40% of delays. The British Association of Day Surgery Bladder Management Flowchart was presented at clinical governance and to the nursing staff. On the second cycle, urinary retention accounted for 21% of delayed discharges. We noted that surgeons frequently documented “home once voided” on operation notes, and nurses were performing bladder scans late in the evening. We encouraged surgeons to document to follow the bladder management flowchart and nurses were advised to do bladder scans earlier in the day. A third data cycle showed that only one surgeon documented for the pathway to be followed but unfortunately this was not followed and 56% of delayed discharges were due to urinary retention.
Conclusions:
This audit was introduced to streamline day care hernia repairs, targeting the commonest cause of discharge delay, urinary retention. Implementation of the Bladder Management Flowchart was shown to reduce delay but is yet to be adopted into the formal day case hernia pathway.