Day surgery facilities in England are underused

More efficient use of day surgery could reduce pressure on hospital beds and waiting lists in English hospitals, according to a review published this week that showed that nearly half of theatre time allocated for day surgery is not being used. The Healthcare Commission, a body that audits NHS services, assessed the way that day surgery was conducted in 313 NHS day surgery units in England.

The commission found that 45% of the theatre time allocated for day surgery was not being used because of cancelled operations, late starts, and excessive delays between operations. The result was that day surgery theatres were being used on average for only 16 hours a week. The commission estimated that an additional 74 000 patients could have day surgery each year, rather than be admitted as inpatients, if the least efficient units started employing the practices of the best.

The review found that one in every 10 day surgery units cancelled more than a third of the available operating theatre sessions. One in four day surgery units cancelled more than 9% of admissions. One reason for this was inadequate preassessment of patients. Almost half of day surgery patients were not assessed for suitability before they arrived for their operation.

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The commission found that the total number of admissions for day surgery for 25 suitable common procedures had increased by 12% in the past four years. Most of this increase was accounted for by cataract operations, however. The ratio of day surgery to total inpatient admissions for some procedures, such as laparoscopy and arthroscopy, had decreased nationally, and some trusts had had an overall decline in day surgery.

Ian Jones, topic lead for day surgery at the Healthcare Commission, said, “This reduction is very disappointing, particularly as the Department of Health is encouraging greater use of day surgery.”

He added, “The reason has nothing to do with lack of capacity.” He explained that for every 28 hours of available theatre time for day surgery, three hours were because of cancellations, six hours because operating lists were not large enough to fill a session, and three hours because of gaps between operations.

Mr Jones considered that lack of dedicated managers for day surgery units was one of the reasons for their inefficient use. Nearly 40% of day surgery units had no single consultant in charge. “If the full benefits of day surgery are to be realised, it is vital that there is a nominated consultant in charge of each day surgery unit,” he suggested.

On the positive side, more patients were receiving good written information before being admitted for day surgery compared with a review four years ago.