Day Case Major Knee Replacement (5th October 2020): Joint BADS & HCUK Conferences Report

Abstract

Joint BADS & HCUK Conferences Report.

Friday 4th of December 2020 saw a joint British Association of Day Surgery (BADS) and Healthcare Conferences UK (HCUK) one- day conference titled “Daycase General Surgery During COVID-19”. This virtual conference is a modification of the previously successful “Developing your Daycase General Surgery Service”. It saw delegates and presenters from across the UK come together from different clinical backgrounds for what promised to be an educational and thought provoking day appropriate for the current climate in view of COVID-19. 

The meeting was chaired by BADS council members: Mr David Bunting, Consultant Upper GI Surgeon from North Devon District Hospital, and Ms Vanessa Cubas, General Surgery Trainee. The first session was delivered by Dr Kim Russon, Consultant Anaesthetist and BADS president. Dr Russon presented a comprehensive overview of the day surgery pathway from GP referral to discharge from hospital and recovery at home, including appropriate patient selection. Importance was placed on dedicated facilities separate from inpatient beds to enable expertise to be developed in managing day case patients. Quality improvement was introduced as a way of widening the inclusion criteria for day case surgery including those who live alone, the older population, the obese, and more complex surgical procedures. It was also an opportunity to introduce the new Sixth Edition of the BADS Directory of Procedures, Model Hospital Tool and BADS Directory of Procedures National Dataset 2020. 

The next part of the morning session introduced the current effects of COVID-19 on elective surgery and day surgery pathways. This session was presented by Professor Doug McWhinnie, President of the International Association of Ambulatory Surgery (IAAS) and Consultant Surgeon. This was further supplemented by a session by Mr Arin Saha, Consultant Upper GI surgeon and National lead for The Surgical Ambulatory Emergency Care Network, who discussed Same Day Emergency Surgery (SDEC). This remains a hot topic across the NHS. Properties of high-functioning surgical ambulatory units were discussed, challenges currently encountered, options of integration of SDEC units with the Think 111 pilot and the future in view of COVID-19. Dr Ian Jenkins, Past President of BADS and IAAS and Consultant Anaesthetist, provided the anaesthetic perspective of the challenges encountered in ambulatory surgery care. 

Just before lunch Mr Charles Hendrickse, Consultant Colorectal Surgeon, discussed the setting up of an extremely successful dedicated COVID-19 free unit for elective surgery for University Hospitals Birmingham. 

Following lunch, Mr Graham Lomax (Deputy National Delivery Director), held a session on the Getting it Right the First Time (GIRFT) national programme that addresses national variation on day case services. He also discussed the London recovery of elective surgery in view of COVID-19, the proposed general surgery pathways and the importance of a collaborative approach with managers and clinicians to optimise outcomes. 

Ms Stella Vig, Consultant Vascular surgeon, gave a session on Croydon Health Services NHS Trust experience on “Cold” site operating and the importance of defaulting to day surgery in the new COVID-19 era and protecting cold/green site pathways. Ms Vig’s unit has been so successful that they have achieved over 100% activity compared to 2019. This was complemented by Senior Charge Nurse Catherine Jack from Queen Margaret Hospital Fife who discussed the units plans to continue with elective surgery during the second wave and gave her valuable experience on encouraging staff wellbeing during this difficult time. 

Following afternoon coffee, Mr David Bunting talked about improving day case laparoscopic cholecystectomy rates and the North Devon experience with the Royal College of Surgeons’ Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) project. Additionally, tips and advice on how to maintain a “Hot Gallbladder” service in the COVID -19 era was discussed. This was followed by Mr Paul Super, Consultant Upper GI Surgeon from the Heart of England Foundation Trust in Birmingham talking about day case fundoplication and anti-reflux surgery. Nationally, the day case rate for anti-reflux surgery is about 15%, however the rate at Heartlands is in excess of 80%, with an overwhelmingly positive patient feedback. Mr Super outlined the patient pathway and general principles for day case hiatal surgery that have enabled the unit to achieve these impressive results. 

A big thank you to all the speakers and all those involved in organizing a successful day conference, and to all the delegates who attended and contributed to the discussion on the day. 

Due to excellent feedback from this meeting, it is being held once again on Friday 4th of June 2021.