Day Surgery Handbook - IAAS Homepage

1 Day Surgery Handbook International Association for Ambulatory Surgery 1 Ambulatory Surgery Handbook 2nd Edition 2014 Day Surgery Handbook International Association for Ambulatory Surgery 2 Contents Foreword .. 6 Introduction .. 7 Design of ambulatory Surgery facilities .. 10 Self contained - Free-standing .. 10 Office based Surgery .. 10 Integrated .. 11 Day ward-dedicated theatre(s) in main theatre complex .. 11 Ambulatory ward-no dedicated theatres.

2 11 Organisational aspects .. 13 Clinical Lead .. 13 Nursing Lead .. 13 Operational Group .. 13 Pre-operative assessment .. 14 Social .. 15 Medical .. 15 Age .. 15 Blood Pressure .. 15 Body Mass Index (BMI) .. 16 Sleep Apnoea .. 16 Diabetes Mellitus .. 16 Patient information .. 18 Procedures suitable for ambulatory 19 Day of admission .. 20 Perioperative Management .. 20 Pain control .. 20 Infiltration anaesthesia .. 20 NSAIDS .. 20 Paracetamol .. 21 Regional Anaesthesia .. 21 Recovery Process .. 22 First Stage Recovery.

3 22 Second Stage Recovery .. 22 Environment .. 22 Hints and tips .. 23 Patient discharge and support .. 24 Discharge analgesia .. 25 Objective .. 25 Day Surgery Handbook International Association for Ambulatory Surgery 3 Drugs .. 25 Paracetamol .. 25 NSAIDs .. 25 Opioids .. 25 Local Anaesthesia .. 26 Topical anaesthesia .. 26 Supply of analgesic drugs .. 26 26 Monitoring Quality use of audit and standards .. 27 Monitoring .. 27 Telephone follow up service .. 28 Appendix A .. 29 The double Role of the anaesthesiologist in Day Surgery Units (DSU): a possible organization model for running an Day Surgery Department.

4 29 Appendix B .. 35 Patient Information Provision: Guidelines and a practical application toolkit .. 35 Introduction .. 35 Criteria for Patient Information Provision .. 35 Categories of Information .. 38 Phases of Information .. 38 Paediatric Day Surgery .. 41 Guidelines for Construction of Information Packets .. 41 Questionnaire .. 44 Examples of information leaflets .. 45 General information leaflet for day Surgery patients .. 46 Information leaflet for Caregivers .. 51 Procedure Specific Information leaflet.

5 54 DAY Surgery Questionnaire .. 57 Links to examples of Patient Information for Day Surgery and Guidelines for Written Material Construction .. 61 Appendix C .. 62 INFORMED CONSENT .. 62 Appendix D .. 65 Day Surgery Procedures .. 65 .. 65 GENERAL Surgery .. 65 BREAST Surgery : .. 66 GYNAECOLOGY .. 67 Day Surgery Handbook International Association for Ambulatory Surgery 4 OPHTHALMIC Surgery .. 67 ORAL AND MAXILLOFACIAL Surgery .. 67 ORTHOPAEDIC Surgery .. 67 PAEDIATRIC 68 PLASTIC Surgery .. 69 UROLOGY.

6 69 VASCULAR Surgery .. 69 Appendix E .. 70 Preventive pain and PONV strategies to optimize quality of care for the day case patient.. 70 Pain Management .. 70 Prevention of Post Operative Nausea and Vomiting .. 71 Appendix F .. 73 Chapter Quality / Clinical Indicators .. 73 Introduction .. 73 Clinical Indicators .. 73 Rationale for using different dimensions Indicators of performance in day Surgery .. 78 Input Indicators .. 78 Access Indicators .. 78 Process Indicators .. 79 Output Indicators .. 79 Outcome indicators.

7 79 Patients Safety Indicators .. 80 Cost / Productivity Indicators .. 80 Patients Satisfaction Indicators .. 81 Conclusion .. 81 Appendix G .. 83 Establishing a formal Association: .. 83 Health care system in India: .. 83 Need for an Association: .. 83 How to go about it: .. 84 Challenges faced: .. 85 International exposure: .. 86 Future Plans: .. 86 Appendix H .. 87 PRE-OPERATIVE ASSESSMENT AND EDUCATION .. 87 Social assessment .. 87 Medical Assessment .. 87 Recovery .. 89 Day Surgery Handbook International Association for Ambulatory Surgery 5 Discharge.

8 90 Post Discharge Follow Up .. 90 Competencies .. 90 Day Surgery Handbook International Association for Ambulatory Surgery 6 Foreword This Handbook was prepared to support the IAAS Train the Trainers programme. Many people have contributed to this publication and I thank them for their support with this project. In particular it is important to recognise the work of Carlo Castoro, Doug McWhinnie, Paulo Lemos, Jan Eshuis and Gamal Mohamed in the development and delivery of the Train the Trainer courses.

9 My hope is that this is just a beginning and that as the course develops then so will the materials available to support this important work. Please note the Handbook is available online at where we have also provided a forum where you can ask questions about any issues you are facing in day Surgery . Ian Jackson President This Handbook arises from the IAAS 2014 WORK PLAN CLOSING THE GAP, which has received funding, in the form of an operating grant, from the European Union, in the framework of the Health Programme.

10 Contributors Ian Jackson President Jan Eshuis Honorary Secretary Luc Van Outryve Honorary Treasurer Gamal Mohamed President Elect Carlo Castoro Immediate Past President Paulo Lemos Past President Arnaldo Valedon Douglas McWhinnie Gamal Mohamed Jan Jakobsson Sven Felsby Naresh Row Day Surgery Handbook International Association for Ambulatory Surgery 7 Introduction Day Surgery or Ambulatory Surgery has many definitions across the world, the IAAS recommend the descriptor Ambulatory Surgery defined as an operation/procedure, excluding an office or outpatient operation/procedure, where the patient is discharged on the same working day.