Training Day 1

Background

Each hospital was encouraged to bring a multidisciplinary team to the meeting made up of managers, surgeons, nurses and anaesthetists. The training was developed with 2 main strands.

  1. To provide education on the day surgery pathway 
  2. To provide time for a workshop session where hospital teams would be facilitated in planning their next steps in developing day surgery.

The IAAS Team was headed by Professor McWhinnie supported by Dr Jan Eshuis and Dr Ian Jackson. They were supported by representatives from the Hungarian Association for Ambulatory Surgery led by Dr Gamal Mohamed.

Programme for the day

Delegates

Name

Hospital

Position 

Dr. Attila BODNÁR

Bajcsy-Zsilinszky Hospital

Director General

Zsuzsanna KALECZ

Bajcsy-Zsilinszky Hospital

Director of Nursing

Dr. Gábor PÓSFAI

Bajcsy-Zsilinszky Hospital

Head Physician

Dr. Róbert RÉVAI

Bajcsy-Zsilinszky Hospital

Medical Director

Dr. Olimpia SÓLYOM

Bajcsy-Zsilinszky Hospital

Deputy Medical Director Head of Ambulatory Care

Dr. Tamás TÓTH

Bajcsy-Zsilinszky Hospital

Head Physician

Dr. Ilona BOBEK

Dél-Pesti Central Hospital

Anesthesiologist Head Physician

Dr. Péter MÜLLER

Dél-Pesti Central Hospital

Medical Director

Dr. Gábor RADÓ

Dél-Pesti Central Hospital

Ophthalmologist Head Physician

Dr. Zoltán KÖKÉNY

Jahn Ferenc Hospital

Medical Director

Beatrix MOLNÁR

Jahn Ferenc Hospital

Nursing Specialist

Dr. Bálint SZELE

Jahn Ferenc Hospital

Surgery Consultant

Dr. Péter SZENTES

Jahn Ferenc Hospital

Anesthesiologist Consultant

Judit GROMAN

National Institute of Oncology

Manager

Dr. Dóra IHAROS

National Institute of Oncology

Anesthesiologist Head Physician

Marianna INÁNCSI

National Institute of Oncology

Head Nurse

Dr. András BENCSIK

Szent Imre Hospital

Head Physician, Deputy Head of Department

Elza BURNYÓCZKY

Szent Imre Hospital

Head of Nursing Unit

Miklosne NÉMETH

Szent Imre Hospital

Director of Nursing

Dr. Bálint PORDÁNY

Szent Imre Hospital

Physician

Ibolya CSERMÁK

Szent János Hospital

Head Nurse

Dr. Zsolt DOMJÁN

Szent János Hospital

Urologist Head Physician

Dr. Anikó LÁZÁR

Szent János Hospital

Anesthesiologist Head Physician

Dr. Gábor SZÓCSKA

Szent János Hospital

Medical Director

Hossem Zeen ABDELKAWY

Uzsoki Hospital

Nursing Specialist

Dr. István MÉHÉSZ

Uzsoki Hospital

Anesthesiologist Consultant

Dr. Balázs TÁCSIK

Uzsoki Hospital

Orthopedics and Trauma Care Specialist, Head Phyisican

Dr. Ferenc TÓTH

Uzsoki Hospital

Medical Director

Plenary session

The initial plenary session led by Professor McWhinnie was designed to provide an overview of the day surgery pathway and provide participants with an outline of how the day would run. The session was supported by simultaneous translation to ensure that those who were non-English speakers were not disadvantaged.

Copies of all slides used are included in this programme for the day.


Breakout group session

The plan was to break the participants into 3 groups with a separate nursing group. However, following a request from the nurses via our HAAS colleagues, we modified this to 2 groups. Therefore, the groupings were

Group 1. Surgeons and managers

Group 2. Anaesthetists and nurses

Each group had a member of the international team leading discussion aided by an interpreter. 

Group 1. The surgeons and managers were led by Professor McWhinnie.

Three topics for interactive discussion

  1. Procedures suitable for day surgery. The initial short presentation confirmed the limitations on suitable procedures and the value of baskets and directories of procedures with the requirement to regularly update or the listings become counterproductive. A short exercise was then conducted by asking each of the assembled group to write down the 7 most common procedures each performed and estimate which and what percentage of each could be performed on a day case basis. The interesting consensus was that the participants were rather conservative in their aspirations.
  2. Operating Room Scheduling. The overview explained the different ways and timing of running day surgery lists and the exercise task was to discuss 7 different patient profiles and decide the list order. Clearly there is no ‘correct’ answer but this topic provoked lively discussion and a realisation that planning day surgery cases requires a little more thought to ensure each patient is optimally scheduled to allow sufficient time for recovery. The need for good and safe preassessment was reiterated.
  3. Operating room turnaround time. The overview highlighted many of the reasons lists fail to commence on schedule and demonstrated through data that actual surgery only occurs in 60% of list time with anaesthetic time and turnaround time accommodating the other 40%. The group exercise here was to consider the most common reasons for each participants’ lists to fail to start on time and how this could be improved. The second question was to consider the reasons for turnaround delays in their hospitals and how this could be improved.

Group 2. The anaesthetists and nurses were led by Dr Jackson and Dr Eshuis.

Dr Jackson presented information about the importance of nursing staff throughout the day surgery pathway and led discussion with those present about issues around nurse involvement in the preoperative assessment process. Dr Eshuis then built on the protocols around patient selection and which patients are suitable for day surgery. There was good discussion during this session from both the anaesthetists and nurses present.

Interactive Session - workshop

This session was designed to challenge the representatives of each hospital to work as a group to design at least one short term goal and something they might achieve in the longer term to improve their day surgery pathway. They were provided with the pathway diagram and encouraged to look at one or two aspects of their current pathway.

To encourage the delegates, they were asked to provide 5-minute feedback from one team member to all the delegates at the end of the task. They were also informed that they would be presenting feedback on their progress on each task agreed at our next meeting in February. They were encouraged to contact us if they needed support during this time.

Pictures from workshop

Feedback session

There were some common themes during the training day.

  1. The first was the current use of routine preoperative testing on patients including both blood tests and chest X-ray. These have long been abandoned in most countries and so we will provide some focus training on this at the next training day.
  2. Next was the lack of use of the WHO Checklist. Patient safety is fundamental to all surgical practice, our aim in day surgery is to act as leaders in promoting safer surgery. We have therefore challenged each unit to develop their use of this important process.
  3. Another topic was around successful anaesthesia in day surgery. The comment being that lack of identification of day cases led to inappropriate anaesthesia techniques being used. We believe that this type of anaesthesia should be used for all patients.
  4. Finally, the discharge process and enabling nursing staff to use criteria-based discharge process was a major topic. This facilitates the day surgery pathway.

Conclusion

The trainers were impressed by the commitment and keenness of everyone who took part. At the next meeting in February we will

  • review progress on their plans
  • provide advice on dealing with any blocks they have encountered
  • cover the topics listed above
  • challenge the teams with further planning on developing their day surgery pathway