British Association of Day Surgery BADS Annual Conference Report 16th-17th June 2022 Notthingham

We never though this day would come when we were actually meeting face to face once more after 2 ½ years away from getting together with no restrictions. This was met with a mixture of emotions, from being very excited to being very anxious. We had held our conference previously here in 2016, so knew that the venue was spacious, airy and large, which would enable delegates to relax and feel safe within the venue. This year we saw another record number of delegates and exhibitors attending the conference, which goes to show that people are ready to get back to face to face meetings but more importantly that we had a fantastic programme with fabulous speakers!! We held our conference in 2021 virtually after having to cancel Cardiff due to the pandemic. Whilst it proved to be a success and had excellent attendance, it was not quite like meeting face to face. Therefore, as an association we were keen to get back to our face-to-face conferences as soon as it was safe to do so following Government Guidelines.

Council started arriving on Wednesday afternoon to prepare for the next two days, as we have done in previous conferences, but it was all under control thanks to Lucy, Lauren and Nic at Event Management Direct, who were given the task to arrange our conference this year. They worked tirelessly in organising the conference and setting up the venue, working with Talking Slides who were managing the AV system for us also the team at Nottingham Trent University Conference Centre all ensuring that the conference went without a hitch! So, a huge thank you to you all in making the conference a success.

And so our conference was underway, our President Jo Marsden opened the conference by welcoming everyone along and by expressing her delight that we were meeting face to face once again and how it promised to be a marvellous two days.

The first session involved three local speakers who work out of Nottingham within this plenary it highlighted the excellent work, which is occuring in Nottingham. It is always good to promote local work and this was no exception.

Dr Mark Barley, a Consultant Anaesthetist, spoke about how using processed EEG Monitoring can improve the quality of anaesthesia for day case surgery. He gave the delegates an in-depth presentation on the benefits of pEEG and he shared some of his clinical pearls

Next up was Ben Gooding, an Orthopaedic Surgeon and Amr Hassan a Consultant Anaesthetist who gave us an overview of their excellent shoulder surgery service and how they have managed to successfully introduce a day case pathway for these patients. They explained that developing a pathway takes time to safely implement and needs involvement from a wide range of stakeholders. The importance of optimising surgical and anaesthetic techniques was stressed. They emphasised that rolling it out for major shoulder surgery is achievable by evidence-based pathways and team engagement.

After coffee, we moved onto the 2^nd Plenary entitled How do I do Day Case…this was an interesting session as it highlighted what can be achieved if a team come together with the same end goal.

First to present was Ms Yasmin Wadedna, Consultant Surgeon from Derby, on Day Case Mastectomy. She gave us an in-depth presentation on how her pathway developed from overnight stay to day case and the challenges that she faced. Next up was Dr Stuart Smith, Consultant Anaesthetist from Sheffield, who spoke about the Pyeloplasty pathway which has been developed in his trust. Lastly Mr Subramanian Narayanan who is a Consultant in Obstetrics and Gynaecology from Torbay and he spoke about their day case service for vaginal surgery, which had been first implemented in 2013. He spoke about the challenges they faced but now the majority of their vaginal prolapse and vaginal hysterectomies are done as daycases, with all vaginal surgeons now working to the same protocol.

There was an excellent discussion after these presentations with good audience participation, which evidenced the interest in this plenary.

It was already lunchtime, which gave the delegates chance to explore the exhibition stands and to view the posters. The quality of the poster this year was high, with a wide range of topics related all related to day surgery, demonstrating the innovative work occurring across the UK.

After lunch we went straight into the 1^st of 2 free paper session of the day, there were 6 in total for this session. Subjects ranging from local anaesthetic hernia repair, complex oncoplastic breast surgery, laparoscopic surgery to COVID-19 and its impact. All presenters gave excellent presentations and provided the delegates with food for thought on how their experience could be implemented in other centres.

Following on from the free paper session were 3 excellent workshops which ran parallel to one another entitled, all subjects which are relevant today and are essential for an efficient daycase facility.

• “Optimising pre- assessment” Chaired by Anne Wright Senior Sister pre assessment and Karen Harries Lead Nurse Day surgery and pre assessment
• “Enabling Change in your Day Case Unit” Chaired by Dr Jane Montgomery, Consultant Anaesthetist and Dr Kim Russon, Consultant Anaesthetist and Clinical Lead for day surgery
• “Wellbeing within the Day Surgery Workplace” Chaired by Dr Emma Plunkett, Consultant Anaesthetist and Dr Jennie Kerr, Consultant Anaesthetist.

We have been featuring these workshop for several years at our conferences and they are always well received, this year was no exception. The workshops give the delegates the chance to network in smaller groups with a topic they are interested in.

After the workshops there was another coffee break and another chance to visit the exhibition stands and posters, there was a relaxed atmosphere and the delegates seemed to be enjoying being back face to face, there was a happy vibe around the conference venue.

So, this brought us onto the last session of the day, prior to the AGM. It was the 2^nd of the free paper session. Again, there were 6 presenters who also gave excellent presentations. Subjects ranged from daycase radiological microwave of liver tumours, bespoke pathway for learning disability patients, tackling backlog of orthopaedic procedures, role of the specialist nurse in urology services, simulation to safety and telephone clinic for listing patients for hernia repair. Again, there were lots of discussion following each of the presentations which I am sure generated lots of ideas which will be taken back to discuss with teams across the UK.

This just left the British Association of Day Surgery Annual General Meeting (AGM), which was held in the main auditorium. Our President Jo Marsden chaired the AGM and she detailed all the work which BADS council members had untaken throughout the year being involved in collaborations with GiRFT, (Getting it Right First Time) currently involved in 8 workstreams, Centre for Perioperative Care (CPOC), Royal College Of Anaesthetists, in Guidelines for Anaesthesia Services for Day Surgery, 2022 edition, Peri-operative Care Collaborative, Association of Perioperative Practitioners (AfPP) in competencies for day surgery and Review of AfPP standards for day surgery, British Society of Interventional Radiology (BSIR) in pathway planning and recommendations for day case rates.

She also highlighted the educational material that BADS Council members had been involved in, working with HCUK in delivering a wide range of day case virtual study days, there are currently 8 study days we run in conjunction with HCUK, all of which are very well attended and have excellent feedback. Also, the introduction of online publications, which are now free to download for BADS members.

Jo concluded her president’s report by thanking all organisations/ collaborations who have been involved in BADS, and especially to all BADS members and our Strategic Alliance Partners, namely AneticAid, Urolift and B-Braun.

There were subsequent reports presented by the Treasurer, Hon Secretary, Conference Team, Journal of One Day Surgery (JODS) Editor, Publications Officer, and Website Officer.

The AGM was followed by an enjoyable drinks reception at the site at the Nottingham Trent University Conference Centre venue. The staff at the conference centre looked after us well and ensured we were topped up with drinks and canapes, while the delegates had chance to network with other delegates and exhibitors in a relaxed environment. It was a fitting end to an excellent first day prior to having the evening free to exploring the sights of Nottingham.

And so, the second day of the conference was upon us, and it was promising to be as good as the first day. The first plenary of the day was going to be a thought-provoking session it was entitled “How Can It be Improved”. Within the plenary we had three speakers all of which are involved in driving forward day case to the norm rather than the exception. The first speaker was our President Miss Jo Marsden, retired Consultant Breast Surgeon, she gave an overview on the variation in national day surgery practice, and how we should be looking to maximise day case rates more so now given the current challenges that are facing waiting lists across the country. She spoke about strategies on engagement and support in developing pathways and how patient involvement, staff engagement, team dynamics and networking with others are essential in the success of new pathway development.

Next to speak was Dr Mike Swart, Consultant Anaesthetist from Torbay, and Getting It Right First Time (GIRFT) as joint clinical lead for anaesthesia and perioperative medicine. Who gave us an overview of GIRFT Day Case Peri-operative Workstream, he commenced his presentation on an overview of GIRFT and how it has evolved. He highlighted some of the developments within GIRFT which has occurred over the last two years, including the development of 29 high volume low complexity surgical pathways, development of the concept of “hubs” of which there are three types, development Model Hospital/Model Healthcare Data and the development of “Gateways” for 7 surgical specialities.

Finally, it was Mr Arin Saha, who is a Consultant General Surgeon and National Clinical Lead for Surgical Ambulatory Emergency Care Network for NHS Elect, who spoke about Same Day Emergency Care (SDEC) and his experiences in setting up this pathway Huddersfield. He talked about following the 10 principles when looking to set up a SDEC but consider the staffing over the location, as they will be the people who will be managing and developing the service. His main message was that one size does not fit all and it is not essential that you must adhere to the 10 principles but use them as a guide.

All these presentations were well received and created good debate and lots of questions were asked following the presentations.

Next was our last coffee break, exhibition and poster viewing of the conference, following on from that was our prize paper session.

Like every year the standard was very high, there were six speakers talking about their experiences and developments within their hospitals. Subjects ranged from: Developing an acute ambulatory urology service, Day Case Masectomies, Day case THA, laparoscopic Adrenalectomy in Day Surgery and Long-term ventilation. It was the audience’s chance to choose the presentation which they felt deserved to be the winner.

Following straight on from the prize presentations was Matthew Checketts, who is a Consultant Anaesthetist working In Dundee and a BADS Council Member part of the Conference team. He gave a keynote talk on his clinical sabbatical which involved visiting 10 different hospitals in 4 countries. He outlined the common threads that facilitated the clinical excellence that these centres were known for. The key ingredients were charismatic clinical leadership with minimal hierarchy, top quality teamwork with a sense of purpose, involving everyone in continuous quality improvement, tightly controlled clinical pathways, and sharing outcome data to generate team pride and desire to strive for success.

After lunch on day 2 there was a session updating the delegates on progress of projects that had been supported by grants from BADS. Lisa Massey from Royal Devon and Exeter hospital talked about staff and patient experiences in their ambulatory care surgical assessment unit. Next was Ruth Burgess a staff nurse from Leeds who discussed their text messaging service for communicating with day case patients. Last in this session was Stefanie Croghan from Trinity College Dublin on the development of patient reported outcome measures for day case hernias.

The Prizes were awarded in the next session by our President, and we are delighted to announce that the winner of the prize paper presentation was Franklin Wou from Frimley Park Hospital with a paper entitled ‘Day Case Mastectomies: The Frimley Park Hospital Ambulatory Pathway’. The winner of the exhibition competition was Leanne McIlwaine, both were presented with £100 worth of vouchers.

A huge thank you for all our presenters who took part in our conference. As ever the standards of the papers and posters were very high this year, we always encourage the authors of submissions to publish in our journal, of which you will find more information on how to submit on our website https://bads.co.uk/

The final session of the conference was proved to be one with a difference. It was hosted by orthopaedic surgeon Hiro Tanaka and looked at a successful day case foot and ankle service in Wales from a variety of perspectives – surgeon, anaesthetist, nurse and perhaps most importantly, patient. The interview style of the session and the use of live demonstrations of ultrasound guided ankle block for foot surgery was interesting and different. It proved to be popular with the delegates and gained very positive feedback. Clinical and ethical issues were touched on, and the humanity and professionalism of the team was evident.

BADS first post pandemic live face to face meeting had proved to be a great success and the organisers were very happy with how smoothly it had all gone thanks to the great help of our events team. President Jo Marsden closed the meeting and delegates emerged from the air-conditioned conference centre to sweltering Nottingham temperatures more than 30C to make their way home to the four corners of the UK. See you all in hopefully a cooler Glasgow for next year's BADS conference on June 29-30^th 2023.

Fiona Belfield

Matthew Checketts