Day Case Hand Surgery Poster

Two Years Experience of Day Case Emergency Hand Surgery in Birmingham A. Mahon, M. McCarthy, M.A.C. Craigen, V. Rajaratnam, O.G. Titley, F. Peart, M.A. Waldram The Birmingham Hand Centre, Selly Oak Hospital, Birmingham, UK.

Introduction

Comparison of Hand Cases Perormed

In November 2003, a day case emergency hand surgery system was introduced to deal with hand trauma at University Hospital, Birmingham. The patients are assessed in the Accident Department by a Senior House Officer or Specialist Registrar on the day of referral, and strict criteria are used to assess eligibility for day case treatment. A Hand Coordinator liases with patients, surgeons and the ambulatory theatre department to organise treatment on consultant led dedicated daytime hand lists. Twelve lists per week serve the current referral load. An escalation policy exists in order to deal with excessive waiting times or large numbers of patients awaiting surgery. This is triggered when more than 8 patients are awaiting surgery or patients wait more than 3 days for surgery. Available lists and staff are sought and, when necessary, an additional theatre list will be organised on a weekend or an evening.

Objectives

Survey of Patients’ Expections Versus Perceptionof Service Using SERVQUAL Tool

The aim of this study was to assess the effect this reorganisation in terms of numbers of patients treated, theatre utilisation and patient satisfaction.

Patients and Methods Data on patients treated has been collected on a prospective basis. Theatre records were used to assess theatre utilisation. Numbers of complaints were recorded with the assistance of the Patient Advice and Liaison Service (PALS).

Results

Year 1 01/04/03-31/03/04

Year 2 01/04/03-31/03/05

The number of patients treated in 2003/2004 was 1261 compared with1725 in 2004/2005, an increase of 37%. Prior to November 2003, only 4% of patients were treated without inpatient stay, 33% of patients were treated in the day surgery unit in 2003/2004, compared with 60% in 2004/2005. This amounts to an estimated saving of 1656 bed days in 2004/2005. PALS received an average of 4 complaints per week prior to implementation of the day case protocol and only 3 in the 2-year period since – a reduction of 99%.

Discussion Prior to the implementation of the Day Case Hand Surgery protocol, we found that the majority of patients referred to our unit were admitted to await surgical treatment. As the majority of such injuries are neither life nor limb threatening, they are not seen as a priority for surgery. This frequently results in delayed treatment, beds being occupied by patients who are receiving nothing more than oral medication, patient dissatisfaction and ultimately, complaints about treatment. The introduction of dedicated day theatre lists for hand trauma and a senior nurse to coordinate the hand trauma lists and liase with patients has improved the situation considerably. Although patients may still wait several days for surgery, they now do so at home. They are informed at an early stage, when they are likely to undergo surgery and cancellations are rare. This has resulted in greater patient satisfaction as indicated by a 99% reduction in complaints. A prior study carried out in our unit has shown further objective evidence of patient satisfaction by using the SERVQUAL tool. Treating hand trauma patients as day cases has not led to an increase in complications and this may be related to the use of a strict protocol. The use of an escalation policy at times when the number of patients requiring treatment exceeds normal capacity has been successful.

Conclusions The introduction of a hand coordinator led, day case emergency hand surgery protocol has resulted in a marked increase in the number of patients treated, and reduced the burden on main theatre. In addition there is better patient satisfaction. We feel that this is a good model for the organisation of a hand trauma service.

The Birmingham Hand Centre