Extended Recovery Facilities

Ambulatory Surgery with Extended Recovery

Definitions
True Ambulatory Surgery

  • This is where patients are admitted, operated on and discharged during the time frame of one working day (6 to 8 hours). There is no overnight stay.

Ambulatory Surgery with Extended Recovery

  • This is where patients are admitted, operated on and stay for one night post-operatively in a hospital facility (overall stay up to 23 hours).

Types of extended recovery

Ward

  • This is to the design of an inpatient ward, is fully nursed and has doctors' rounds.

Hospital Hotel

  • This is to the design of a 2 to 3 star hotel. Patients are cared for by staff who are not nurses, but have the attributes of a good and caring relative. There are no doctors' rounds.

Why extended recovery developed

Ward

  • Initially in the private sector by freestanding day units to increase their range of surgery and boost their income.
  • In public healthcare systems to meet government " day surgery" targets without increasing true day surgery.

Hospital Hotel

  • To allow those living alone to have day surgery and recover in non-clinical surroundings with surrogate relatives.

Advantages extended recovery

Ward

  • Extends patient base for private freestanding day units thus maximising return on investment.

Hospital Hotel

  • Allows patients living alone to enjoy the benefits of day surgery .
  • Hotel cost per night (1/4) that of being in a ward.
  • Can also be used for staged discharge of inpatients who live alone.

Disadvantages extended recovery

Ward

  • Cost per night at least the same as a normal inpatient ward.
  • Has the same management and organisation as an inpatient ward.
  • Staffing costs may be higher than normal inpatient ward if there are not the maximum number of beds for the minimum nursing levels eg: at night 2 nurses are a minimum requirement and they can care for 20 patients.
  • Reduces the pool size and flexibility of usage of inpatient beds. (If 23-hour wards are sensible then there should also be 48-hour, 72-hour, 96-hour, etc wards. Clearly this is unmanageable) .
  • Introduction may delay the development of true day surgery or even reverse move to day surgery.

Hospital Hotel

  • Costs more than true day surgery, but less than inpatient or ward care.
  • May be used inappropriately as a convalescent or geriatric unit.