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General Orthopaedics

WHY DO DAYCASES STAY OVERNIGHT? AUDIT AND REAUDIT OF AN INTERVENTION TO IMPROVE DAYCASE THROUGHPUT BY EARLY COMMUNICATION WITH THE MULTIDISCIPLINARY TEAM

The South West Orthopaedic Club (SWOC) Spring Meeting



Abstract

Daycase surgery has advantages for patients, clinicians and trusts. The Best Practice Tariff uplift is £200/case for Minor Foot Procedures performed as daycases. Before discharge, Foot & Ankle daycase procedures in Cheltenham General Hospital require physiotherapy assessment and frequently an orthotic aid. This audit analysed length of stay of daycase patients on a Foot and Ankle list. The standard was 100% of daycase patients to be discharged the same day.

Length of stay for a consecutive series of patients was calculated for all daycase procedures from October to December 2010. An intervention was made comprising a weekly multidisciplinary bulletin from the Orthopaedic Consultant. This highlighted post-operative weight-bearing instructions and orthotic requirements for forthcoming daycase patients to physiotherapists, nursing staff and junior doctors. The data was compared with a second consecutive series of patients from October to December 2011.

The first series included 38 listed daycases of which 61% (23 patients) were daycase discharges. The second series comprised 41 listed daycases who received pre-operative physiotherapy assessment and provision of required orthotic aids; 85% (35 patients) of this group were discharged the same day. Data analysis using Fisher's exact test reveals this intervention had a statistically significant impact on the number of patients discharged the same day (p < 0.0207).

The financial implications are increased Best Practice Tariff with an £1800 uplift and reduction in the estimated cost of unnecessary overnight stays of £4640 over the 3 months. Improved multidisciplinary communication can significantly improve the patient experience, bed occupancy and cost of care.