In 2013, Victoria Hospital's Day Surgery Unit (DSU) performed 354 cases, saving an estimated 552 bed days and generating $168,090 in revenue. The DSU, opened in October 2012, saw increasing utilization over the year from 40% bed occupancy in the first trimester to 72% in the final trimester of 2013. The presentation evaluated the DSU's history, case volumes, financial assessment, and concluded the unit was providing benefits in terms of reduced hospital stays and increased revenue for the hospital.

1. 
Day Surgery/Victoria
Hospital DSU Audit
Presenter: Dr. E. M. Regis Jr. MD
House Officer Dept. Of Gen Surgery/ Ortho
12/03/14

2. Outline
 Overview
 VH DSU History
 Number of cases per trimester from Oct 2012 – Dec 2013
 Assessment of the finances
 Summary

3. Definition –
surgical procedures that are performed which do not
require an overnight hospital stay.
<23hr hospital stay

4. Selection of patients
Patients referred from; outpatient clinics, A&E departments or primary
care.
Recent advances in surgical and anaesthetic techniques, as well as the
publication of successful outcomes in patients with multiple comorbidities,
have changed the emphasis in day surgery patient selection.
It is now accepted that the majority of patients are appropriate for day
surgery unless there is a valid reason why an overnight stay would be to
their bene t.fi

5. It is recommended that a multidisciplinary approach, with agreed
protocols for patient assessment including inclusion and exclusion
criteria for day surgery, should be agreed locally with the
anaesthetic department.
Patient assessment for day surgery falls into three main categories:
1)Social Factors
2)Medical Factors
3)Surgical Factors

6. Social Factors
 (a) The patient must understand the planned procedure and
postoperative care and consent to day surgery.
 (b) Following most procedures under general anaesthesia, a
responsible adult should escort the patient home and provide
support for the rst 24 hrs.fi

7.  (c) The patient’s domestic circumstances should be appropriate for
postoperative care.
 (d) The patient must live a reasonable distance from the centre.
 (e) The patient must have access to transportation & telephone.

8. Medical Factors
 (a) Fitness for a procedure should relate to the patient’s health as
determined at pre-operative assessment and not limited by
arbitrary limits such as ASA status, age or BMI.
 (b) Patients with stable chronic disease such as diabetes, asthma
or epilepsy are often better managed as day cases because of
minimal disruption to their daily routine.

9.  (c) Obesity per say is not a contraindication to day surgery as even
morbidly obese patients can be safely managed in expert hands,
with appropriate resources.
 In addition, obese patients bene t from the short-durationfi
anaesthetic techniques and early mobilization associated with day
surgery.

10. Surgical Factors
 (a) The procedure should not carry a significant risk of serious
complications requiring immediate medical attention
(hemorrhage, cardiovascular instability)
 (b) Postoperative symptoms must be controllable by the use of a
combination of oral medication and local anaesthetic techniques.

11.  (c) The procedure should not prohibit the patient from resuming
oral intake within a few hours.
 (d) Patients should usually be able to mobilize before discharge
although full mobilization is not always essential. (e.g. certain
orthopedic cases)

12. History
 Day Surgery Unit (DSU) opened on October 15th
, 2012.
 First case was the following day, October 16th
, 2012.
 DSU is staffed with 2 nurses, and houses 3 patient beds.
 DSU is opened Monday – Friday. (8am-4pm)

14. Oct 15th
– Dec 20th
2012
Intermediate 18
Minor 40
Cancel 4
Total 62
Intermediate cases for this trimester range from hernia repair, leep
biopsy, OGD.
Minor cases comprise mostly biopsies, exploration, removal of
plates and screws, extraction of external fixation.

15. Oct 15th
– Dec 20th
2012

16. January – March 2013
Intermediate 34
Minor 26
Cancel 1
Total 61
Majority of intermediate cases were hernia repairs, insertion of
hemodialysis catheters, leep biopsy and scopes.
The minor cases for this trimester were I&Ds, change of tracheostomy,
insertion of chemoport, excision and biospy.

17. January – March 2013

18. April – June 2013
Intermediate 58
Minor 39
Cancel 5
Total 102
Majority of intermediate cases were OGDs (>1/2 cases due to teaching
by foreign professional), hemodialysis catheter insertion, colonoscopies.
Minor cases ranged from circumscion, tendon release, FB removal,
excision and biopsies.

19. April – June 2013

20. July – September 2013
Intermediate 37
Minor 32
Cancel 4
Total 73
Intermediate cases for this trimester included hernia repairs, increase in the
number of upper and lower GI scopes due to new team member (Ms. A.
Charles), AV fistula, ORIF.
Minor cases included FB removal, tendon release and usual excision and
biopsies.

21. July - September 2013

22. October – December 2013
Intermediate 69
Minor 59
Cancel 12
Total 140
Intermediate cases included OGD, hernia repair, cystoscopy, LEEP,
laparoscopy.
Minors ranged from closed reduction, wound exploration, wound
closure, excision and biopsy, suprapubic catheterization.

23. October - December 2013

24. Jan 2013 – Dec 2013

25. Departmental Users Of DSU (2013)

26. Assessment Of The Finances
 Processing Fee $10
 Bed $ 75
 Intermediate $500
 Minor $250

27.  We estimate that before the advent of DSU, any minor case,
patient(s) would be admitted for at least 2 days, and intermediate
3 days.
 So DSU essentially reduces days spent in hospital, hence increases
bed availability on wards.
 Potentially there is an increase/assured revenue as patient(s) pay
in advance

28. 2013
 Intermediate Cases: 198 x $585 =
$115,830
 Minor Cases: 156 x $335 =
$52,260
 Total Revenue Estimated
$168,090

29.  Forecast of “estimated bed days” saved
Minor 1 day
Intermediate 2 days
In 2013….
Minor Cases 156 x 1 = 156 bed days saved
Intermediate 198 x 2 = 396 bed days saved
Total = 552

30.  Bed occupancy of DSU
Work days per trimester x Available beds
 1st
Tri (Jan-March) …. 59 x 3 = 177
 2nd
Tri (April-June) …. 62 x 3 = 186
 3rd
Tri (July-Sept.) ….. 62 x 3 = 186
 4th
Tri ( Oct.-Dec.) …. 59 x 3 = 177

31. % of bed occupancy
(Patients/ Bed Occupancy) x 100%
4th
trimester (2012) 40.3%
1st
trimester (2013) 33.9%
2nd
trimester (2013) 52.2%
3rd
trimester (2013) 37.1%
4th
trimester (2013) 72.3%

33. Summary
 2013, a total of 354 cases were done with an estimated 552 bed
days saved.
 2013, a total bed occupancy of DSU was estimated to be 726.
 Total revenue estimated to have been generated from DSU in
2013 was $168,090
 From opening DSU, percentage bed occupancy increased from
40% in 1st
tri to 72% at the end of 2013.

34. Acknowledgements
 Special thanks to Dr. A. Charles who assigned me this VH DSU
research project and now by extension presenting it.
 Also thanks to VH DSU staff, especially Nurse B. who provided
me with numerical data and photos for this presentation.
 Last, to my colleagues who provided support in whatever way
possible.

35. References
1) Royal College of Nursing
2) Day Case and Short Case Surgery, The British Association of
Day Surgery, The Association of Anesthetists of Great Britain &
Ireland,
May 2011
3) www.google.com/images