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Parent Section: A History of Day Surgery in Australia
Model Day Surgery Complex with Extended Recovery and Medi-Motel
Day Surgery in Australia is now well established in both the private and public health care sectors.
There has been a remarkable development of freestanding day surgery centres, the great majority of them being in the private sector. At the present time, there are 191 freestanding day surgery centres, 326 private hospitals and 774 public hospitals (48 of which are teaching hospitals).
These freestanding day surgery centres are of the same day type ie. patients attend for their operations/procedures and are discharged on the same (working) day. The remarkable technological developments in diagnostic, therapeutic and operative equipment, together with the increasing costs of acute bed hospital services, will stimulate further expansion of day surgery to include patients having more major operations, who are currently treated as inpatients.
A recent paper "An alternative to acute bed hospitals based on the day surgery principle" 1 discussed the schematic prototype of a day surgery/procedure and a non-procedural acute care complex. It was suggested that this complex, based on the day surgery principle, might be considered as an alternative to traditional acute bed hospitals for a variety of surgical and medical services. The capital and ongoing costs of such a complex would be significantly lower than an equivalent acute bed hospital. The complex includes the concepts of extended (overnight) recovery for selected patients and post-discharge convalescent accommodation – Medi-Motel.
The detailed model plan of a day surgery/procedure centre, which includes extended (overnight) recovery and a Medi-Motel, is illustrated in figure 1. It also includes other important design features such as a community nurses centre and a pre-operative assessment clinic. Details of the model are discussed below.
Model Day Surgery Complex
The primary module is a day surgery centre of typical design and contains four operating rooms, although the number can be varied.
Adjacent to the admission area is a conference room, which can also serve the important function of day surgery education, utilising all the modern electronic communication equipment.
Theatre 1 is next to the change room/pre-op area and would be most appropriate as a minor operating and/or endoscopy room. These patients have the shortest recovery times and would pass through to the discharge lounge without entering the major operating area.
There are two anaesthetic/store room bays for the major operating rooms. These are particularly important where a significant number of patients would have spinal/epidural or other major regional block anaesthesia.
The majority of patients would progress from the primary recovery area directly to the discharge lounge and the design of the centre features the ideal flow path for patients.
The second module of this complex is the extended recovery area adjacent to the primary recovery area and includes a separate nurses station. This module includes five such rooms, however the number can be varied depending upon the type of surgery and anticipated use.
The third module, a separate unit connected to the extended recovery area, is the Medi-motel which provides comfortable post-discharge convalescent accommodation for patients prior to their return home. A typical room would contain two beds, one for a carer, together with ensuite facilities, and there is a lounge-dinning area for patients and their relatives/friends.
In the Medi-motel wing there is a community nurses centre which can provide nurse services to the Medi-motel and to patients in their homes.
A pre-op assessment clinic is located next to the community nurses centre with access from within the day surgery centre and outside.
The Model is presented as a free standing centre, however the design is flexible such that it can be modified and integrated as a free functioning unit within an existing hospital, public or private. It is also modular so that it can be constructed as a whole or as separate modules.
The capital and ongoing costs of the Model complex would be greatly less than a typical acute bed hospital of the same patient capacity.
In summary, serious consideration should be given to the future development of day surgery centres as discussed above as an alternative to acute bed hospitals. The Model would be particularly suited to rural and peripheral metropolitan areas.
1. An alternative to acute bed hospital based on the day surgery principle. L.Roberts 1999 The Australian Surgeon 23, 1 13-19