17 Day Case ENT Surgery

A day case patient is one who has a planned admission, operation and discharge on the same day. Anaesthesia is modified to allow rapid recovery and to minimise post-operative pain, nausea, and vomiting. Pre-admission planning and protocol-driven, nurse-led discharge allow a day unit to run efficiently. The option of day case surgery is largely governed by the unit facilities, the type of surgery and patient factors.

17.1 Introduction

Day surgery is continually evolving. In recent years, the complexity of procedures suitable for day case surgery has increased. Protocols devised with the local anaesthetic department have allowed many patients with a range of comorbidities to have day surgery. The pre-operative preparation should determine a patient’s fitness to undergo day surgery. Such surgery tends to be determined by age, American Society of Anesthesiologists (ASA) status and body mass index (BMI). Acute conditions or patients on a target pathway can be treated effectively as day cases too. It is recommended that each unit has a clinical lead to develop local policies, guidelines and clinical governance. Detailed advice leaflets should be available as should a robust discharge protocol and effective audit.

17.2 Definition

An ear, nose, throat (ENT) surgical day case patient is one who has a planned admission for operation and discharge on the same day. The definition of ‘same day’ is not as obvious as one might think. In the United Kingdom, it is defined as the same calendar day. In the United States, it is defined by a 24-hour window such as being admitted after 7:30 a.m. on day 1 and discharged by 7:00 a.m. the next day. In the United Kingdom, this would be defined as a 1-day stay, but the problem then arises, if a hospital has a 24-hour staffed day unit and the patient stays overnight on that unit and not in an inpatient bed, as how to define the stay. Most would simply define it as a 1-day stay on a day unit. There may be financial implications for this, because in the U.K. clinical commissioning groups pay an enhanced tariff for many procedures performed as a day case. The corollary of this is that hospitals need to have agreements with the local commissioning groups as to what stay provides an enhanced tariff before deciding on whether investing in a 23-hour ‘day unit’ is financially viable.

17.3 The Day Case Unit

The patient may be admitted into either a self-contained day surgery unit with its own admission suites, wards, theatres and recovery area. Less desirably, a day case ward is used with patients transferred to a main theatre. Stand-alone day case units, sited away from a major hospital, have become reasonably common in the United Kingdom. Facilities for recovery are required. Full admission procedures and records are required, which therefore excludes those operations and procedures undertaken in the outpatient or accident and emergency department.

17.4 Surgical Factors

Previously, this chapter listed procedures suitable for day case surgery, but very few ENT operations now would routinely require an inpatient bed. Major whead and neck surgery, including anterior and lateral skull base surgery would fit into this small group. A sensible approach might be to have day case surgery as a default option for surgery so that the surgeon would then, in effect, be asking if there is any reason why surgery cannot be performed as a day case.

Stay updated, free articles. Join our Telegram channel

Join