It was with a heavy heart, but we knew it was the responsible course of action to cancel our face-to-face meeting, which was first planned for June 2020, then re-arranged for March 2021 due to the Covid -19 pandemic and organise a virtual conference. This was new territory for BADS, and we approached it with trepidation.
The day of the conference came quickly, and we were absolutely delighted to have had a record number of delegates, nearly 400 from around the world registering for our 1st virtual conference.
The conference commenced with Dr Kim Russon President of BADS welcoming delegates and promising a full day of high calibre lectures and speakers, with a wide range of specialities all speaking on their experiences in managing the re-commencement of day surgery following the Covid-19 pandemic.
The first session was delivered by Professor Tim Cook, Consultant in Anaesthesia, and Intensive Care Medicine, at Royal United Hospital, Bath who spoke about “Covid -19 and the challenges facing elective surgery.”
This session was well received and generated lots of discussion on the challenges facing the NHS. The main message from Professor Cook was that recovery from Covid-19 is going to be a marathon and not a sprint. He also emphasised that elective surgery could only resume when there is physical space available, staff have returned to substantive posts and most importantly staff wellbeing needs to be supported. This will require workforce planning at all levels and consider training needs for trainee doctors. Fundamentally, patients will require re-assessment due to potential change in a patient’s condition.
The second session was titled: “Why and how should you default to day surgery to maintain elective pathways” and delivered by Professor Tim Briggs, Chairman of the Getting It Right First Time (GIRFT) programme and National Director of Clinical Improvement at NHSE and Dr Mary Stocker, Immediate Past President of BADS.
Professor Tim Briggs gave an overview of the work he is doing with GIRFT and the London recovery of elective surgery programme. This project has been very successful in increasing day case rates by setting a target of achieving 85%-day case rates across all specialities and standardising pathways. He summarised that if we are to achieve higher day case rates, we need something different and urgently. This will require utilising the GIRFT methodology, standardising pathways, refining theatre principles and improving day case patient flow.
Dr Mary Stocker followed by giving us an overview on day case pathways, how these should be developed and what should be included. She stressed the importance of the need to stretch the boundaries of day surgery; expand the range of procedures performed in the day surgery setting and widen patient selection criteria, if day surgery is to play a pivotal role in recovering elective surgery after Covid -19. Mary gave reference to the Model Hospital and the Day Surgery Delivery Pack; a collaboration with BADS and GIRFT. They are both excellent guides as to what can be achieved as day case. These resources give good practical advice and a platform to be able to network with day case units that perform well in certain procedures. She also emphasised that to achieve the best outcomes, day case units should be dedicated units with expert staff, have up to date equipment and a lead individual who will drive day surgery within their trust and standardise pathways. By implementing these trusts will be able to start to recover elective surgery with minimal impact on inpatient beds.
The third session was delivered by Dr Chris Snowden and Dr Mike Swart, both GIRFT National Clinical leads for Anaesthesia and perioperative medicine. They presented on “Variation in day case surgery: GIRFT Anaesthetics and perioperative medicine national report and reducing variation.” Dr Chris Snowden gave a detailed overview on the report. His principal message was that recovery of elective surgery is going to be slow and that we all need to be working collaboratively to achieve the best possible outcomes. He also concluded that day surgery should be accepted as the default for elective surgery and the importance of measuring day case data.
Dr Mike Swart presented and summarised the GIRFT pathways and the implementation of day case pathways. He emphasised the importance of such pathways, and that it is essential to start with primary care, working through to discharge. He focused on GIRFT gateways and the National Day Surgery Delivery Pack as integral tools to improve day case rates further in England. Once this has been achieved, GIRFT will start to look a pre-assessment, inpatient then emergency pathways, although he feels that this can only be achieved by continuing to work closely with BADS, Preoperative Centre for Perioperative Care, relevant associations, and colleges.
After the coffee break and a chance for delegates to view the posters and exhibition, it was back to business. Session 4 comprised the prize presentations, which I always enjoy listening to. This part of the conference highlights all the hard work and commitment of teams in driving day surgery forward. This year was no exception, the standard of all presentations was high with a record number of abstract submissions, 75 in total. We heard from 6 presenters selected for the prize session with specialities including: orthopaedic surgery, maxillofacial surgery and urology. We asked delegates to vote for the best presentation using the Slido facility and I am pleased to announce that First Prize was awarded to Lindsay Hudman, Glasgow Royal Infirmary, for her presentation “The Coronavirus Pandemic: A catalyst for the accelerated development of a successful new orthopaedic service in Glasgow.” Second prize was awarded to Nimlan Shanmugathas, Imperial College NHS Foundation Trust for his presentation on “Early Experience of Primary Transurethral water vapour treatment (Rezum ®) for symptomatic Benign Prostatic Hyperplasia: an analysis of 332 consecutive patients”. Congratulations and a big thank you to all the presenters in the prize session who spoke and provided the delegates with their thought-provoking and innovative work occurring across the UK.
This concluded the morning session with the afternoon session tailored to specific specialities and how these specialities managed to continue with operations during the constraints of the Covid-19 pandemic. The afternoon speakers demonstrated resilience and determination of teams that work within the NHS and commitment in providing the highest quality of patient care without compromising patient safety.
Five specialities were included in this session. The first speaker was Mr David Bunting, a Consultant Upper GI Surgeon working in North Devon District Hospital. He spoke about laparoscopic cholecystectomy and how they managed to reduce length of stay and increase day case activity by introducing a “Hot-gallbladder pathway” for patients presenting to the Emergency Department or via urgent GP referral. He concluded that although Covid-19 has been detrimental to elective services, the unique challenges have presented healthcare trusts with opportunities to develop new pathways that promise to delivery positive benefits for all patients in the long-term.
The second speciality was Gynaecology and Mr Peter Scott a Consultant Gynaecologist from Plymouth gave his talk on how his team succeeded in moving gynaecological procedures from a day theatre to out-patients. He gave an overview of the procedures that were moved to an outpatient setting and associated new pathways that have been developed. These include, Novasure Endometrial ablation, Myosure Morcellation, manual vacuum aspiration for miscarriages and surgical termination of pregnancy. He explained that moving these procedures into this environment is a more cost-effective way to manage these patients. Covid-19 has had a positive impact on services by taking opportunities to develop the service with shorter waiting times, freeing up theatre sessions, and reduced patients length of stays. Patient feedback from the introduction of this service has been very positive, outcomes have improved, and activity has increased significantly by adopting new ways of working.
The third presentation was on day case total hip replacement as a day case presented by Dr Claire Blandford, Consultant Anaesthetist from Torbay and South Devon NHS Foundation Trust. Key recommendations for introducing a successful total hip replacement pathway included looking at inpatient management and how this can be adapted to a day case pathway. She emphasised that the patient’s mindset should be positive and geared to go home the same day, encouraging this concept as soon as possible, ideally from pre-assessment. Creating targets to work towards and analysing data along with optimal peri-operative and post-operative management of pain, a robust standardised protocol, and a ridged discharge plan, should all be in place if day case hip replacements are to succeed. She also emphasised that networking with other units performing day case total hip replacements and learning from them can help them create a successful pathway. Torbay are achieving 94%-day case total hip replacements as present, which is very impressive.
The Maxillofacial session was delivered by Miss Francine Ryba, Consultant Oral and Maxillofacial Surgeon, from King’s College Hospital, London, and Mr James Douglas, registrar in Oral and Maxillofacial Surgery, from Leeds Teaching Hospital. These presentations compared two different teams and how they set about creating a pathway for repair of fractured zygoma as a day case. It was interesting to hear two different reports of how, why and when their pathways were developed. King’s College commenced this pathway because of the Covid -19 pandemic, whilst Leeds Teaching Hospital has been successfully achieving these for 10 years. Both spoke that due to the length of time eye observations must be completed, as the risk of bleeding and compartment syndrome, make it more difficult to achieve as a day case, so both stated that these procedures should be completed on a morning list. There is ample time for these observations to be completed within the day. Although Mr James Douglas highlighted that when they were looking at past research, the incidence of this complication was relatively rare. The main conclusion from both units was that in order to achieve a successful pathway, there must be good teamwork and a dedicated pathway. Mr Jiten Palmer, a Consultant OMFS, from Leeds Teaching Hospital, joined in with the discussion following the presentations.
This led us to the final presentation in this session, which saw Mr Feras Al Jaafari talk about how he successfully changed the pathway of ureteroscopy from an inpatient to a day case. They commenced this change in 2018 due to inpatient bed pressures and theatre lists regularly being cancelled. The findings were positive, and they increased their day case rate to 85% when the procedure was moved into the day case setting compared to 17.6% in an inpatient setting. There was no change in re-admission rates or complications by performing this in a day case unit, which confirms that it is a safe procedure to perform in this setting. There was a significant financial saving with 28.2% to 50.3% reduction in costs by moving into a day case setting. This was also associated with a reduction in length of stay. He concluded by informing the delegates that they now perform 85.3% of ureteroscopies as day cases offering this pathway by default to all suitable patients. Importantly, the patient perception is key to ensuring patients are discharged on the same day.
There was a period of live discussions following each of the five presentations which provoked lots of questions and debate and keeping our moderators busy. These presentations were brief (15 minutes) but focussed, providing a detailed and informative insight into the innovative work being undertaken in our forward-thinking day surgery units throughout the UK.
This bought us onto our last session of a very full programme for our first virtual conference. It was the turn of pre-assessment to be presented and again we had two speakers who spoke about their experiences and challenges and how Covid-19 has changed their practice. Mrs Karen Harries, Lead Nurse for Day Surgery and Pre-Assessment at King’s College Hospital, London spoke first. Her presentation concentrated on her experiences of Covid -19 and how they had to change their practice and adapt to new ways of working, that ensured Covid -19 guidelines were followed but at the same time the patients were optimised for their operation. She shared the changes that were implemented quickly to maintain pre-assessment flow. For example, patients were pre-assessed via telephone prior to surgery and any pre-operative tests to be performed on the day of surgery. This limited the number of times the patient had to visit the pre assessment unit. They created a generic email, so anaesthetists that were shielding could review patients. The undertook a very small survey to see patients’ thoughts on the telephone assessment and unsurprisingly, the fit and well patients preferred this method but the patients who were not so fit did not feel comfortable with simply a telephone assessment. Karen concluded by sharing some of the good effects that came out of the Covid -19 pandemic, and they have now moved away from face-to-face for ASA 1 and 2 patients but will still manage the ASA 3 and 4 patients through video-link or face-to-face. They are looking to introduce community hubs within the community, so vulnerable patients can have tests performed without having to visit the main hospital.
It was then Dr Christina Beecroft’s turn to present. She is the Clinical Service Director in Elective Perioperative Care, working in Ninewells Hospital, Dundee. This presentation concentrated on the developing strategies on how best to manage safe elective surgery through the pandemic by developing a pre-surgery isolation pathway. They ask patients to isolate for 14 days prior to their surgery and the patients take a Covid-19 test on their first day of isolation, then a second one 48hrs prior to their surgery. Even though the timescale is short to optimise these patients, they have succeeded in the management of these patients. This is down to the determination and commitment of the team and collaboration and communication between different departments. One aspect they will continue are the regular meetings with the waiting list team to optimise scheduling in advance. This ensures good communication with all involved in scheduling patients and an opportunity to discuss any potential problems and offer solutions working in a collaborative manner.
Dr Kim Russon, President of BADS, drew our conference to a close, and thanked all the presenters for their input into a full day of excellent presentations. She recognised all the good work that is being achieved throughout the UK and was encouraged by the active participation of delegates on the day. They were enthusiastic in the chat and she hoped this would interaction would continue beyond the conference.
It just leaves me to mention the winners of the posters, and as ever there was a high standard of abstracts this year. With a record number of posters, 63 in total. We divided them into 4 categories and below are the winners from each category. Congratulations to all that submitted an abstract and we always encourage authors to submit their abstracts for consideration of publication in JODS. Details on how to submit an abstract can be found here:
Mohammed Shaath, Northern Care Alliance, Manchester
7 years of Day Case Uni-compartmental Knee Arthroplasty for all-comers within the NHS: The journey and evidence of sustained change
Lewis Powell, Prince Charles Hospital, Merthyr Tydfil
Emergency Day case surgery to east pressures caused by Covid-19
Ruth Burgess, Leeds Teaching Hospitals Trust
Pre-operative Communication in Day-Case Surgery: Patient views of text messaging and access to online information for elective day-case surgery
Rebecca Janes, Nottingham University Hospitals
Perioperative care of inguinal hernia repair and length of stay
Rachel Heard, Royal Preston Hospital, Manchester
Paediatric Fasting Times Audit
Rory Colhoun, The Rotherham NHS Foundation Trust
Successful Day Case Uni-compartmental Knee Replacement (UKR) at The Rotherham NHS Foundation Trust
Victoria Peacock, Airedale General Hospital, West Yorkshire
Ensuring safe and timely discharge following spinal anaesthesia for Day case; creation of Nurse-led discharge criteria at Airedale General Hospital
Rachel Tibble, Royal Derby Hospital
The Effect of Centralisation of Preoperative Assessment on Day Surgery List Efficiency
One final congratulation goes to Rachel Tibble, as the winner of the exhibition competition. Well done Rachel on working out the answer.
The correct answer was:
“Using day surgery to recover elective surgery in the era of Covid-19. British association of Day Surgery is at the forefront of achieving this.
This just leaves a couple of announcements to make. Firstly, Janet Mills who has been our exhibition Manger for 14 years retired earlier this year. She has worked tirelessly for BADS in managing and organising our exhibitors for our conferences. I am sure you will all join with BADS to wish Janet a long and happy retirement.
Thank you to all our exhibitors for the on-going support.
I would also like to thank the Talking Slides team on behave of BADS. They were the “Brains and brawn” behind what was such a successful conference. Their commitment and professionalism throughout the organising of the conference was incredible and we just could not have achieved such success without them.
A huge thank you to all our BADS members new and old for all your support. We look forward to seeing you at Nottingham in 2022, 16th and 17th June.