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Parent Section: A History of Day Surgery in Australia
A History of Day Surgery in Australia
The Australian Day Surgery Committee commenced as a working party to prepare the first guidelines on day surgery in 1981. As day surgery expanded, slowly at first, the activities of the working party increased and in 1988 its name was changed to the National Day Surgery Committee. There has been more rapid expansion of day surgery over the past 10 years, and in 1996 it became the Australian Day Surgery Council, which currently has representatives from 23 health care organisations.
Day surgery is carried out in both free standing and hospital based centres. By the end of 1999 there were 190 free standing day surgery centres in Australia, most of them multidisciplinary with a small but increasing number of unidisciplinary centres. These centres have been of the 'same day type' however Council has supported the introduction of extended (overnight) recovery units in day surgery centres – “23 hour day surgery” – and Medi-motel convalescent units. It is predicted that within five years approximately 75% of operations / procedures will be carried out as day surgery.
A successful day (ambulatory) surgery centre/unit must have two fundamental criteria. It must provide operative services of high standards of quality and safety. It must be both patient and cost efficient such that it is financially sustainable. ... Day surgery can be provided in freestanding centres or in units within hospitals - there is no preferred model. Freestanding centres are the most patient and cost efficient, and the true costs of providing day surgery services can be collated from data provided by these centres. (March 2005)
The detailed model plan of a day surgery/procedure centre, which includes extended (overnight) recovery and a Medi-Motel, is illustrated. 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 (Australian Surgeon Volume 23, No. 1 Summer 2000)
The greatest challenge to the health care system in Australia, and other countries, is the escalating cost of technological advances, diagnostic and therapeutic, together with the costs of acute-bed hospital accommodation. It is obvious that only the largest hospitals can afford to provide all the complex expensive diagnostic technology, yet it is essential that it should be available to all levels of the Australian community. This can only be achieved by providing these services in the community (outside the hospital system) with private funding. The large hospitals, generally of teaching hospital status, can offer these services, but only to a very small proportion of the population (Australian Surgeon Volume 23, No. 1 Summer 1999)
Many intermediate and some more major operations are suitable for day surgery but are still being treated for two or more days in acute bed hospitals, both public and private. ... Over the past 21 months, the Australian Day Surgery Council has considered a number of fundamental day surgery principles which will have a significant influence on the further expansion of Day Surgery in Australia (Australian Surgeon Winter 1998)
The initiative of the medical profession to formalise the establishment and development of high quality day surgery facilities was expressed in a paper entitled "Introduction and Establishment of Day Only Facilities and Services", and adopted at a meeting of the New South Wales Committee of the Australian Association of Surgeons on 16 June 1980. (Australian Surgeon Winter 1997)
Day surgery services are provided in hospital based units, private and public, as well as in free-standing centres. Some hospitals have constructed separate free functioning day surgery units, however in many hospitals this ideal situation does not exist and day surgery patients are mixed with overnight stay patients. The cost advantage of day surgery is best achieved in free-standing centres or totally free-functioning units within acute bed hospitals. (Australian Surgeon Winter 1997)
The National Day Surgery Committee was formalised in 1985 to address standards for Day Surgery Facilities. In 1988 its scope was extended to advise on measures that would encourage the success of quality day surgery. The preparation of this paper is a continuation of this role to demonstrate the possible savings which may be achieved by a determined strategy to encourage a change in designated procedures from Overnight to Day Only surgery (Australian Surgeon December 1995)
The Chairman of the National Day Surgery Committee, Mr Lindsay Roberts, presented a speech at a national conference on health care delivery organised by I.I.R. Conferences in September, last. The speech was entitled "Day Surgery - The Past, Present and Future", and the following is an edited version of the address (Australian Surgeon December 1994)
The following paper was prepared for publication in 'Ambulatory Surgery', which is the recently established international journal on ambulatory surgery, and includes Comment on suitable Clinical Indicators identified by the National Day Surgery Committee. Several other Clinical Indicators which were considered unsuitable have also been mentioned. The subject of quality assurance is under consideration by the International Committee as one of the major topics for the first International Congress on Ambulatory Surgery, to be held in Brussels March, 1995 (Australian Surgeon April 1994)
The construction and licensing of day surgery centres is a State responsibility and each State prepares its own mechanism for this purpose. Where a licence has been granted to a day surgery centre there is a simple process of registration with the Federal Government for the payment of day surgery facility insurance rebates. A separate body, the Australian Council on Health Care Standards is the accreditation organisation for the maintenance of standards (Australian Surgeon August 1993)
"Incentives for the Expansion of Day Surgery" has been prepared by the National Day Surgery Committee as a stimulus for the expansion of day surgery in Australia. It will be widely distributed to the medical profession, organisations involved in the delivery of health care, Government and other interested parties. (Australian Surgeon June 1992)
A meeting of the Expanded Day Surgery Committee ... met on June 2 this year to conduct an interim examination and assessment of overnight certification and banding of Day Surgery Procedures which took effect from December last year. (Australian Surgeon August 1990)
The Australian Association of Surgeons has taken a Pioneering role in Developing High Day Surgery Standards. A review of the years 1980 to 1990. (Australian Surgeon August 1990)
A decision by Medicare to subdise disadvantged patients for Day Surgery services would provide added support for the development of these efficient, cost effective facilities and at the same time help reduce the Federal Governments Health Care Expenditure. (Australian Surgeon October 1988)
The Guidelines have been drawn up by Mr Lindsay Roberts following in-depth study of the development of Day Surgery facilities in Australia and the USA. (Australian Surgeon August 1987)
There are many advantages of day surgery, not only to patients and the medical profession, but also to nurses, health insurance funds and Government. It is the cost effectiveness of day surgery which should appeal to Government and the health insurance industry, and this cost effectiveness is illustrated by comparative costs of patients treated in day surgery facilities compared to the same patients treated in overnight bed hospitals. (Australian Surgeon August 1987)
The most important Activity of the committee to date has been the preparation of standards for day surgery facility accreditation culminating in the publication of a "Manual for the Accreditiation of Day Surgery Facilities" (Australian Surgeon February 1987).
It is estimated that over 40% of all operations in the USA are now carried out in Day Surgery Facilities and with the ever increasing costs of overnight hospital beds, day surgery is expected to expand even further. In Australia there are only a handful of free standing day surgery facilities but it is anticipated that their numbers will rapidly increase. (Australian Surgeon July 1986)
Extract from a media release in Adelaide by Mr. DG Macleish, President Royal Australian College of Surgeons, May 1986.
The Final Report on Day Surgery has now been presented to the Federal and State Health Ministers who have accepted the recommendations of the report in principle.