46 Booked! Direct Booking For Day Case Surgery

Conference: 
Author(s): 
M.J. Wilkinson, M. Goldman, F.D.R. Hobbs
Sutton Coldfield
Text: 
Background:
There is a long wait for patients to have an operation in the UK. This has generated public concern. The government has sponsored a number of projects to reduce waiting times. After seeing a GP a patient may wait up to 12 months for an outpatient appointment, then are put on the ‘waiting list’, a further 9 months, until they have their operation. The total waiting time can be over 12 months.
Aim: 1. To reduce waiting times by a minimum of 3 months. 2. Give patients a date of operation within a few days of seeing their GP. 3. To identify day case procedures, suitable for directly booking on to the day case surgery list by a GP with no outpatient assessment.
Methods: Randomised controlled study comparing direct booking of up to 12 surgical conditions with outpatient assessment. Protocols for referrals emergent design being agreed by surgeons, anaesthetists and GPs. GPs serving Heartlands and Solihull NHS trust recruited and trained for direct referral. Referral protocols identify anaesthetic fitness, confirmation of diagnosis and pre-operative counselling by GP. Referral is by facsimile, with feedback of date of operation or outpatient assessment within 7 days. Outcome measures: percentage of direct referrals received, waiting times, cancellations and delays, protocol violations for direct booking, consumer satisfaction, and safety.
Results: The project finishes in June 1999. 53 GPs have been accredited for direct referral. Final list of 9 surgical procedures agreed for direct referral including inguinal hernia, ganglia, Dupuytren’s contracture, carpal tunnel syndrome, trigger finger, male and female sterilisation, adult circumcision and vasectomy. Some procedures have proved more popular, for example, vasectomy and male circumcision, less popular procedures include carpal tunnel decompression. Initial outcome data will be presented.
Conclusion:
This project demonstrates that GPs can work with hospital consultants to agree referral protocols. For some day case surgical procedures an outpatients appointment is restricted to doubts about diagnosis or anaesthetic fitness. It is hoped that this referral system can be extended to include other procedures and be adapted to an Internet referral system.
Literature: 
46 Booked! Direct Booking for Day Case Surgery