Day of surgery admission for the elective surgical in-patient: successful implementation of the Elective Surgery Programme

Concannon, Elizabeth; Hogan, Aisling; Flood, L M; Khan, Waqar; Waldron, Ronan; Barry, Kevin

doi:10.1007/s11845-012-0850-5

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…Outcomes were identified as:- best practice guidelines, models of care, protocols, pathways; education and training; new services; improved discharges; improved patient outcomes; reduced length of stay; timely access; reduced waiting lists; cost effectiveness and the benefits of other intangible outcomes such as clinical leadership. The findings from this study on positive outcomes from implementation of the national clinical programmes concur with some of the literature in this area (Concannon et al., 2013; Cunningham et al., 2012; Currie et al., 2010; Ferlie et al., 2010; Gaston and Rice, 2003; Goodwin et al., 2004; Guthrie et al., 2010; Haines et al., 2011; Laliberte et al., 2005; Lega and Sartirana, 2011; O’Reilly et al., 2015; Ray-Coquard et al., 2002; Sheaff et al., 2011; Tolson et al., 2007); (c) structurally, the number of clinical programmes should be condensed and prioritised in an aligned fashion across the continuum of care from secondary to primary care and out of the perceived longitudinal ‘silos’ of a particular division to span the five operational HSE divisions. Although no particular suggestions were offered by the participants as to how the national clinical programmes should be condensed and prioritised, they did all state support for the current HSE strategy to integrate clinical programmes and structure the implementation approach across all five HSE operational divisions including prevention, primary and secondary care in an integrated way.…”

Section: Discussionsupporting

confidence: 89%

National clinical programmes in the Republic of Ireland: a qualitative study of acute hospitals

Shaw

2020

Journal of Research in Nursing

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Background The national clinical programmes (NCPs) were established in 2010 to achieve three objectives, namely: improve quality, access and cost effectiveness. Limited research exists on their implementation in the Republic of Ireland (ROI). This qualitative study identified key stakeholders’ perceptions on (a) implementation thus far, and (b) conditions perceived necessary for implementation in acute hospitals. Aims The overall aim of this research was to undertake an in-depth study to explore from the perspectives of key stakeholders, their perceptions on implementation of the national clinical programmes, thus far, in relation to three overarching objectives (to improve quality, access, cost effectiveness) and what are the conditions necessary for their implementation in the Republic of Ireland's acute hospitals. Methods Twenty participants were interviewed using face-to-face audio-recorded semi-structured interviews. Transcribed data were coded and analysed, and a number of themes emerged from the dataset relating to the study aims. Results Implementation was perceived as being inconsistent. Outcomes were identified as: best practice guidelines, models of care, protocols, pathways; education & training; new services; improved discharges; improved patient outcomes; reduced length of stay; timely access; reduced waiting lists; cost effectiveness and other intangible outcomes. Sixteen conditions, under four themes, were perceived necessary for implementation, namely: Governance – structure, audit & monitoring, senior management support, accountability, and clear objectives and expectations; Communication – visible face-to-face engagement, internal awareness, and external awareness; Leadership – programme level, national level, hospital level, and professional level; Resources – budget, staff, information technology, training, skills, and competency. Conclusions This study adds to the existing limited body of knowledge on implementation of the NCPs in the acute hospitals in the ROI while contributing to the wider international literature in this area. The study provides hitherto unreported knowledge on the conditions that are perceived necessary for implementation. Novel in the ROI context is the perceived necessity to condense the number of NCPs, placing greater emphasis on (a) the need to structurally integrate the NCPs across the continuum of care, and (b) the importance of communication through visible face-to-face engagement. This study concludes that significant progress has been made by the NCPs towards meeting the objectives, albeit to varying degrees. There is a strong perception that the NCPs should remain, and that addressing the conditions perceived necessary for implementation in the areas of governance, communications, leadership and resources by both top-down senior health officials and bottom-up front-line hospital staff would significantly enhance the ability of the NCPs to meet objectives and implementation. It provides the ROI health services with valuable information to inform future reform, strategic planning and NCP implementation.

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Section: Discussionsupporting

confidence: 89%

National clinical programmes in the Republic of Ireland: a qualitative study of acute hospitals

Shaw

2020

Journal of Research in Nursing

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“…ERAS has been shown to facilitate a cohesive, streamlined approach to elective surgery yielding significant saving in terms of hospital bed days [2, 6] and improved patient satisfaction [6, 12, 20, 21].…”

Section: Discussionmentioning

confidence: 99%

Using Lean Six Sigma to improve rates of day of surgery admission in a national thoracic surgery department

Brown

Grehan

Brennan

et al. 2019

International Journal for Quality in Health Care

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ObjectiveThe aim of this study is to improve rates of day of surgery admission (DOSA) for all suitable elective thoracic surgery patients.DesignLean Six Sigma (LSS) methods were used to enable improvements to both the operational process and the organizational working of the department over a period of 19 months.SettingA national thoracic surgery department in a large teaching hospital in Ireland.ParticipantsThoracic surgery staff, patients and quality improvement staff at the hospital.Intervention(s)LSS methods were employed to identify and remove the non-value-add in the patient’s journey and achieve higher levels of DOSA. A pre-surgery checklist and Thoracic Planning Meeting were introduced to support a multidisciplinary approach to enhanced recovery after surgery (ERAS), reduce rework, improve list efficiency and optimize bed management.Main Outcome Measure(s)To achieve DOSA for all suitable elective thoracic surgery patients in line with the National Key Performance Indicator of 75%. A secondary outcome would be to further decrease overall length of stay by 1 day.ResultsOver a 19 month period, DOSA has increased from 10 to 75%. Duplication of preoperative tests reduced from 83 to <2%. Staff and patient surveys show increased satisfaction and improved understanding of ERAS.ConclusionsUsing LSS methods to improve both operational process efficiency and organizational clinical processes led to the successful achievement of increasing rates of DOSA in line with national targets.

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“…Part of the comprehensive documented positive effects are higher patient satisfaction, medical advantages such as the reduction of nosocomial infection rates and the financial relief of hospitals as well as health care systems [6][7][8]. German hospitals also experiment with the introduction of the DOSA principle [9].…”

Section: Documented Benefitsmentioning

confidence: 99%

Untitled

2016

JACCOA

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Introduction: Inpatient admission on the day of surgery-in jargon "Day of Surgery Admission" (DOSA) is an in many countries widely introduced care principle. There it is already implemented in the treatment standards and combined with fixed target rates. Advantages like higher patient satisfaction , reduction of nosocomial infections or higher cost effectiveness have been proved by earlier studies. German hospitals focus primarily on the punctual start of surgical procedures, optimization of transition times between two surgeries or surgical management. Some of them are already working with the DOSA principle. The study analyzes the current implementation rate of DOSA in Germany and the hidden financial potential of a consistent implementation. Case Presentation: Underlying data include the routinely compiled inpatient documentation of German hospitals as well as the results of the annual quality reports and the hospital benchmark of IGES Institute. The study analyzes if and if so, to which extend the DOSA principle is already implemented in German inpatient care for the surgical procedure of cholecystectomy. Based on the assumption that a DOSA rate of 85% for eligible patients is feasible financial savings are then estimated for the case that preoperative inpatient days could be reduced by one day per case (for non-DOSA cases). The results are then translated into an estimation for the whole inpatient sector and sorted by major diagnostic categories (only for procedures with operative codes relevant for grouping in the contract for ambulatory surgeries). Conclusion: In 2013 the preoperative inpatient period for cholecystectomy procedures averaged at 2.1 days per case. The DOSA-rate for those surgeries was at 47.6 percent. That translates into a DOSA potential of approx. 46,000 occupancy days or 126 hospital beds (reduction by one preoperative inpatient day per case). The financial impact of a consistent implementation results in 11.9 million Euro of savings solely for gall bladder surgeries (260.54 Euro per case). In case the number of preoperative inpatient days is reduced to zero for eligible cases the savings would increase up 25.1 million Euro (547.13 Euro per case) or approx. 265 hospital beds. Considering not only cholecystectomy but a nearly complete set of DOSA relevant procedures the analysis for those surgeries results in a DOSA potential of 510,774 cases per year and 138 million Euro in savings. The scale of the calculated figures in this projection evoked by consistent implementation of the DOSA principle is of significant relevance to individual hospitals, as well as the entire inpatient service provision in Germany.

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Day of surgery admission for the elective surgical in-patient: successful implementation of the Elective Surgery Programme

Cited by 11 publications

References 8 publications

National clinical programmes in the Republic of Ireland: a qualitative study of acute hospitals

National clinical programmes in the Republic of Ireland: a qualitative study of acute hospitals

Using Lean Six Sigma to improve rates of day of surgery admission in a national thoracic surgery department

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