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Parent Section: A History of Day Surgery in Australia
Day Surgery Plan Gains Wide Acceptance
Lindsay Roberts, FRCS FRACS
Chairman, Australian Day Surgery Council, 1990 – 2000
President Elect, International Association For Ambulatory Surgery 1999
The campaign for the establishment of day surgery units is gaining momentum.
Hardly a week goes by without some mention in the public media of the need to establish a facility in which patients can receive minor surgery procedures without incurring the costs generated by even an overnight stay in an acute hospital bed.
The final report on day surgery prepared by the joint Working Party of the Royal Australasian College of Surgeons, the Australian Association of Surgeons, the Faculty of Anaesthetists of the Royal Australasian College of Surgeons and The Australian Society of Anaesthetists has now been presented to the Federal Minister for Health and State Minister for Health and all have accepted the recommendation of the report in principle.
The major health funds are also in favour and it would appear to be only a matter of time before a fund benefit rebate is agreed and day surgery units come into being. In the light of all these developments AAS members should not overlook the important, indeed vital role played by the Australian Association of Surgeons to bring matters to their present stage.
Indeed, the AAS was instrumental in both establishing the feasibility of such units and in persuading other interested parties of the need for a system which ensured a high standard of patient care, yet which still allowed costs to be contained.
In May 1980 Lindsay Roberts first presented a paper on day surgery to the NSW Committee of the AAS.
His paper was taken up by Federal Council and after considerable work the joint Working Party was established under the chairmanship of E. Durham Smith.
By now most surgeons are well aware of the advantages of day surgery units.
in summary, day surgery allows the treatment of large number of patients at less cost than in-patient surgical treatment for the same conditions.
As the report states, costs are reduced because staff and facilities are not needed at night at weekends or on public holidays; fewer staff are required for a day surgery centre than for in-patient surgery; acute beds in hospitals are not needlessly taken up.
A survey mentioned in the report suggests that up to 25 per cent of patients who occupy acute hospital beds could be treated in day surgery units.
Hospitals will benefit not only because of economic savings.
Recruiting problems will be eased because hours on duty in a day centre will suit part-time or married people; and fewer short stay patients will allow in-patient facilities to be run more efficiently.
The preparation of records, the examination and preparation of patients for operations and post-operative care, and discharge of short stay patients, also detract staff from the care of patients with major illnesses.
Advantages to patients and their relatives include less anxiety because an overnight stay in hospital is avoided, a quicker return to normal activities including work, and less stress for relatives who will not need to spend time and often money on travel and even accommodation to visit the in-patient.
The report states that the type of facility required for a day surgery already exists in many public and private hospitals and could be available in free standing facilities constructed specifically for this purpose.
But it stresses that the standards of patient care offered at administrative, clinical and technical levels must be as good as those provided in in-patient accommodation. (Recommended surgical standards and procedures are outlined later in this article.)
In order to ensure that standards of care are maintained, the report recommends that day centres be registered with State health authorities and the registration be on the basis of accreditation by an appropriate committee.
It envisages the need for a federal representative committee responsible for establishing standards.
This would be the Australian Council on Hospital Standards or a subcommittee of that body.
Each state or territory should have a licensing authority responsible for regulating, registering and accrediting individual centres.
And each centre should have its own executive committee to manage and monitor performance and ensure the complete observance of standards.
Of course, there are still some procedural matters to be finalised before day surgery centres come into being.
With the backing of government at all levels, the funds and the active support of all those involved in and responsible for patient care in Australia, these can be quickly solved.
There is no doubt that day surgery centres, if established and run along the lines recommended by the joint Working Party, will be successful.
And the money saved can be put to good use in correcting growing deficiencies in Australia's health services.
Surgical Standards and Procedures for day centres listed in Appendix B of the report are as follows;