British Association of Day Surgery

Annual Conference

27 -28 June 2019
Royal Society of Medicine, London

This year’s conference was a milestone for the British Association of Day Surgery (BADS), as it was the 30th year since the organisation was founded. The venue itself was very impressive and being in Central London enabled delegates to attend from far and wide. This year, once again, saw a record number of delegates attending from all around the world, namely Australia, South Africa, China, Switzerland, Belgium, Iceland, and Croatia. It is encouraging for BADS that the importance of day case and short stay surgery is recognised not only in the UK but internationally.

Once the Presidents welcome and housekeeping had been delivered it was straight into the first plenary session with presentations on “Implementing a day case gastric bypass service” delivered by the team at St George’s University Hospital NHS Foundation Trust in London including expert speakers Mr Marcus Reddy, Consultant General Surgeon, Mr Omar Khan, Consultant Bariatric Surgeon, Dr Ajit Kayal, Consultant Bariatric Anaesthetist and Dr Nick Fletcher, Consultant Anaesthetist. The session was well-received and informative. It was a pleasure to hear from Mr Derek Carpenter, a patient who had undergone day case gastric bypass, to share his experiences.  All too often we listen to the professionals on the management/implementation of pathways and tend to oversee the most important person, the patient, whose active participation is essential in successfully introducing any new pathway.

After coffee we moved onto the second plenary session, which promised to be thought provoking and interesting, entitled the “Presidents’ Plenary”.  As it was our 30^th Conference we wanted to celebrate by inviting two past presidents of BADS and our current President to speak on topics that they feel passionate about.

Professor Doug McWhinnie Consultant Surgeon from Milton Keynes started the session by talking about environmental issues and how in day surgery can we help to tackle these problems.  He discussed recycling, unnecessary waste and potential ways in which we can help in reducing the waste we produce, not just in the work environment but in our everyday lives as well.  This lecture was inspirational giving the delegates food for thought in how their units could do their bit to help to tackle environmental issues and providing motivation to achieve this in their everyday lives as well.

The second lecture of the President’s plenary session was given by Dr Ian Jackson, retired Consultant Anaesthetist providing an interesting talk on how technology can improve a patient’s day surgery journey by increasing the effectiveness and efficiency of the pathway. Examples of this included online preoperative assessment and web-based patient information portals.  Dr Jackson provided further insight into tackling environmental issues, explaining how technology could be used to reduce paper used in the work environment.

The final talk in the President’s plenary session was delivered by our President, Dr Mary Stocker. She highlighted the ever-increasing range of procedures now routinely undertaken in day surgery, detailed in the new edition of the BADS Directory of Procedures and how we can optimise our day case rates by developing pathways to adapt into the day surgery setting.  She also discussed the new Model Hospital website, which benchmarks day surgery rates against all the procedures that are in the BADS directory.  This enables the user to identify top performers in the country so they can learn from their experiences and share their knowledge. 

All speakers gave inspirational presentations and produced good debate amongst the delegates, I am sure what was presented will be fed back to Day Surgery teams throughout the UK and beyond to enable the improvement of the management of services and patient experience with an emphasis tackling environmental issues.

The afternoon programme started with the first of our parallel free paper session. The standard of presentations was high reflecting a large number of high-quality abstract submitted to the conference.  It is always encouraging to see so many submissions as it demonstrates all the hard work that is occurring amongst the day surgery teams throughout the country and abroad.  Subjects included, ‘Improvement in breast surgery’, ‘Improving informed consent for laparoscopic cholecystectomy’, Improving quality in operation notes in day case surgery’, ‘Re-audit of fasting policy’ and many more.  All these presentations will be made available to BADS members for viewing on the BADS website.

The free paper session was followed by three parallel workshops:

• ‘Day case spinal anaesthesia’, chaired by Dr Ben Fox, Consultant Anaesthetist and Dr Anna Lipp, Consultant Anaesthetist
• ‘Does everyone need a carer for 24 hours?’ Chaired by Ms Francine Horide, Staff Nurse in preoperative assessment and Dr Jane Montgomery, Consultant Anaesthetist
• ‘Optimising your day case pathway’, chaired by Mrs Fiona Belfield, Senior Sister Day Surgery and Dr Theresa Hinde Consultant Anaesthetist

Feedback from all sessions was positive and generated interesting debate, allowing the delegates to ask questions and gain advice from the chairs as to their experiences in the subjects discussed. BADS have been running individual workshops for several conferences now. They are a good forum for networking with colleagues who encounter the similar issues and offer an important opportunity to seek specialist support and advice.

The final session of the first day commenced with the second parallel free paper session. A wide variety of subjects was presented and both sessions were well attended. Titles included ‘Retrospective Audit Examining On The Day Theatre Cancellations’, ‘Service evaluation of parent bleep for children having day surgery’, ‘Day case Laparoscopic Cholecystectomy in East Africa’ and ‘Management of postoperative urinary retention in day surgery utilising the international prostate scoring system’.

The BADS Annual General Meeting (AGM) was held in the main auditorium. Mary Stocker, BADS President detailed all the work Council members had undertaken throughout the year.  This includes the introduction of our conference app and the Slido system, both measures aimed at improving the delegates’ conference experience; publication of the 6^th edition of the BADS Directory and its launch that the conference and the commencement of talks regarding accreditation and its future within day surgery.   She welcomed new BADS Council members, namely, Adam Kimble, Edward Dunstan, Karen Harries and Shaun Clee, our new lay member.  She thanked outgoing Council members Dr Anna Lipp, Paul Rawlings and Anna Girolami for their hard work and commitment during their time on Council.

Reports were presented by the Treasurer, Hon Secretary, Conference Secretary, Journal of One Day Surgery (JODS) Editor, Publications Officer and Website Officer.  All reports are available to view on the BADS website.

The AGM was followed by a drinks reception on-site at the Royal Society of Medicine.  This was well attended and welcomed after a full programme on the first day.  It gave the delegates a chance to network with exhibitors and other attendees in a relaxed environment, prior to an evening that would leave the delegates free to explore the sights of London!

Friday started with a Urology-themed plenary session. This was a multidisciplinary session with a presentation from Mr Mark Rochester a Consultant Surgeon from Norwich, talking about the different day case techniques and treatments available for Benign Prostatic Hyperplasia. Dr Mary Stocker, Consultant Anaesthetist from Torbay discussed anaesthetic techniques, which enable urology patients to undergo procedures such as TURP, laser prostatectomy, and Urolift as a day case procedures. The session was concluded by Alex Alen, Senior Sister at Torbay Hospital. She gave an insight into the importance on preparing the patient for day case surgery at pre assessment and that planning for more complex procedures pre-operatively is the key for a successful same-day discharge. This session highlighted the importance of good communication and team work amongst the multi-disciplinary team.  

The urology plenary session was followed by the prize presentation session. The six highest-scoring abstracts were presented. They were scored by three expert judges and an audience vote via the Slido app.  Topics varied from ambulatory free-standing bed-less facility to developing a pathway for upper limb arthroplasty.

Moving straight on from the prize presentations was one of the highlights of the Conference, Professor Doug McWhinnie Consultant Vascular Surgeon and General Surgeon, Milton Keynes and Dr Ian Smith Retired Senior Lecturer in Anaesthesia both past presidents of BADS debated “All slow surgeons and slow anaesthetists should be banned from Day Surgery”.

Both debaters gave convincing arguments to support their viewpoints. The debate unfolded with great humour and much banter, providing hugely entertaining and thought-provoking material for discussion.

The afternoon session began with a presentation for the winner of the prize presentations, this year going to Graham Harris for his talk on ‘Improving fluid fasting times and postoperative nausea rates after introducing a liberal preoperative fluid policy for patients undergoing elective surgery’.  

Well done Graham! Unfortunately Graham was unable to collect his prize, as he had to travel back for an on-call that night, the prize being received by a colleague on his behalf.

Again, I would like to take the opportunity to thank all those individuals who submitted their work for presentation at this year’s Conference, and we encourage all presenters to publish their work in the BADS Journal of One Day Surgery (JODS). Submission information and author guidelines can be found on the BADS website.  Each year the quality of submitted abstracts seems to get better and it is reassuring that there are so many aspects of Day Surgery being studied, which leads to improvements and developments in the field of day case and short-stay surgery throughout the UK and further afield.

Following the presentation of prizes, Mary Stocker formally handed over the Presidential reign to Kim Russon. Kim thanked Mary for all her hard work and is looking forward to her time as President.

And so, it came to the last plenary session of the conference, entitled ‘Hysterectomy and Enhanced Recovery’. The team from Royal Surrey County Hospital, Guilford shared their experiences.  Again, this was a multi-disciplinary session, so the audience could benefit from the experience of different members of the team. Ms Wendy-Rae Mitchell, an Endometriosis Specialist Nurse spoke first, discussing the history behind the enhanced recovery programme, its purpose and how it has improved vital communication with patients undergoing such a potentially life-changing operation. She emphasised the need to take into consideration cultural beliefs amongst many factors and the impact such an operation may have on these patients.  It also ensures that the patients are prepared both physically and emotionally for such an operation given that the patient will only be in hospital for a short time.

Next to present was Dr Piers Johnston, Consultant Anaesthetist, who gave us an overview of the peri-operative management and Enhanced Recovery in relation to day case hysterectomy, which included a review of pre-operative preparation, per-operative pain relief options and patient positioning to ensure positive patient experience and safety.

The final talk at the Conference was delivered by Mr Andrew Kent, Consultant Surgeon, giving an overview of ‘Laparoscopic Hysterectomy Intrafascial (LHi) Technical Aspects, Benefits and Desired Outcomes’ and how this enabled the Enhanced Recovery Programme to become successful.

Again this demonstrated how working as a team and bringing each of the elements together, enabled this to become the success that it is today.

And so this closed another successful conference with delegate numbers exceeding 200 and a real buzz was felt over the two days which is encouraging. I am sure the delegates who attended the conference felt inspired and motivated in bringing back to their individual units what they have learnt and what could be improved with their work environment.

It is always reassuring to know that there are so many Day Surgery units endeavouring to provide the best service and achieve the best outcomes possible. BADS would like to take this opportunity to acknowledge all the hard work and dedication amongst the teams to help to make this happen. Please keep up the good work, as without you this would not be possible.

I would also like to take the opportunity to thank everyone who participated in making this year’s our 30th conference so special, and for the delegates who attended for enabling us to continue to strive to always push the boundaries of Day Surgery.

Look forward to seeing you in Cardiff in 2020.

Fiona Belfield

Conference Secretary