Fan, JKM

Law, WL

Yuen, WK

HKU Scholars Hub

Title Featured day surgery units: day surgery in Hong KongAuthor(s) Fan, JKM; Law, WL; Yuen, WKCitation The Journal of One-day Surgery, 2008, v. 18 n. 4, p. 97-100Issued Date 2008URL http://hdl.handle.net/10722/59980Rights Creative Commons: Attribution 3.0 Hong Kong LicenseThe Journal of One Day Surgery | 97Featured Day Surgery Units: Day Surgery in Hong KongKeywords: Day surgery facilities; International practiceJOE KM FAN, WAI LUN LAW & WAI KEI YUENBackgroundMedical infrastructure in Hong Kong is mainlygovernment funded, although charity groups subsidisesome hospitals in addition to central funding from theGovernment. The whole territory, which has a populationof eight million, is served by seven hospital clusters.Despite the fact that some hospitals have started a schemeof “Self-Financed Items” in which patients are required topay the cost of expensive drugs, such as newchemotherapeutic agents and special instruments for someoperative procedures, an average patient pays as little asUS$12 per day for in-hospital charge, which includes theroom as well as all investigations and treatments duringthe hospital stay. The remaining cost is fully covered bythe Hospital Authority of the Hong Kong SpecialAdministrative Region (HKSAR), China.Under these circumstances, there is no apparentmotivation for patients to be treated as day cases, as thecost for finding a care-giver or for travelling may be muchmore than staying as an inpatient for several more days. Inaddition, many Chinese patients still hold the belief thatthe outcome following an operation is better if they aretreated as an inpatient. Moreover, in the past, the medicalpersonnel were not keen to promote day surgery services,as this would result in more work with no extra rewards toboth themselves and the departments involved. The viewthat the implementation of day surgery might decreaseinpatient bed occupancy, with a resulting reduction inresource allocations, was also an obstacle to thedevelopment of ambulatory surgery.Concerning surgical training in Hong Kong, there is nodesignated module for day surgery. The application of daysurgery requires careful selection of cases and special careby specialists. In addition, the physical setup and scale ofday surgery facilities varies greatly among the differenthospital clusters (Figures 1 & 2): some are well equippedwith operating theatres and nurse specialist forperioperative care; whereas some only comprise a smallside-ward with a few beds with nurses being deployed fromother surgical wards during normal working hours.Despite these limitations, ambulatory surgery has grownand developed substantially in recent years in Hong Kong.The organisation of hospitals into clusters ensures that thepatient can receive public medical care with easyaccessibility and the time for a patient to travel to thenearest hospital is expected to be less than an hour. Thistranslates into easily accessible help and reassurance if apatient encounters any problems after the operation,which may range from minor wound oozing to a severeabdominal catastrophe. Although Chinese patients stillhold a belief that an operation is a very major event andthey should be treated as inpatients, the short travellingdistances, well established ambulance service, easilyassessable help and support from day surgery centres,combined with better community education all helppersuade them to accept this “new concept” of care. SomeAuthors’ AddressesJOE KM FAN Resident (Specialist) in Surgery WAI LUN LAW Clinical Professor of SurgeryWAI KEI YUEN Consultant Surgeon,Department of Surgery, The University of Hong Kong, Queen Mary Hospital,Pokfulam, Hong Kong Special Administrative Region, ChinaFigure 1 Patient waiting area and recovery bay, United Christian Hospital, Kowloon East ClusterFigure 2 Recovery Bay, Alice Ho Miu Ling Nethersole Hospital, New Territory East Cluster98 | The Journal of One Day Surgery | VOL 18 | No 4of the measures taken to overcome the obstacles to thedevelopment of day surgery in Hong Kong include theallocation of dedicated facilities, simplified operationalpolicies for staff, designated surgical teams and appropriatefunding and planning mechanisms with regular audit. Daysurgery services have relieved much of the work in somehospitals with high occupancy rates (e.g., university-basedhospitals and clusters serving the lower social classpopulation). The efforts and achievements in thedevelopment of day surgery have been recognised by aworking group of the Hospital Authority of Hong Kong. What is your level of activity?According to a statistical report by the Working Group onthe Future Role and Development of Ambulatory Surgery,about 1,600 inguinal hernia operations, more than 1,300breast operations, about 350 anal surgeries and 150laparoscopic cholecystectomies were performed annually asday cases among all cluster hospitals in HKSAR, China1. InTung Wah Hospital, a university-based day surgery centre,day surgery comprised 19.47% of all operations performed inthe hospital in the past seven years from 2001 to 2007(average 112 out of 573 operations per year)2. With theprovision of a designated team of surgeons, anaesthetists andspecially trained nurses, the outcome has been encouraging.Only 0.47% of patients failed to turn up for the operationand the rate of cancellation of operations was 1.36%.Conversion to inpatient care occurred in 4.2% of patients,with the majority of cases due to wound pain and theperformance of a procedure more major than expected. Thereadmission rate after discharge was 1.7%. This successreflects a good administrative program, ranging from patientselection, preoperative counselling and education (Figure 3),perioperative care, home care and follow-up.How do you run preassessment?In addition to a day surgery service, some centres providepreanaesthetic assessment, patient education (Figure 4),endoscopy services or a one-stop clinic for specific surgicalconditions. This multidisciplinary approach to patient carenot only optimises the usage and allocation of resources, butthe quality of care is also improved. Patients are assessed onan outpatient basis with all essential investigations performedbeforehand. If they are deemed unfit for same day discharge,because of medical or social reasons, they will be admitted asinpatients on the day, or the day before an operation.Recovery and Nurse-led dischargeOf the seven established day surgery centres in Hong Kong,there is a great variation in the magnitude of physical setupand manpower involved. The setup can be as little as a smallpatient waiting room (Figure 5), from where the patients aretransferred to the operating theatre and discharged directlyfrom the recovery area or after returning to a general ward.Other centres have a designated floor for day surgeryservices, with a well decorated reception area (Figure 6),consultation rooms, dedicated operating theatres andrecovery bay (Figure 7) within a comfortable and homelyenvironment. The scale and scope of services simulates acommunity day hospital and patients benefit from the highquality professional surgical care and education. After theoperation, patients are assessed by nurses for fitness fordischarge (Figure 8), with the final approval granted by theanaesthetist and the attending surgeons.What would you like to develop or furtherdevelop?The wider application of minimally invasive surgery andimprovements in surgical techniques and perioperativeFigure 3 Explanation of day surgery to newly admitted patients, Pamela YoudeNethersole Eastern Hospital, Hong Kong Island East ClusterFigure 4 Patient information board, Alice Ho Miu Ling Nethersole Hospital, New Territory East ClusterFigure 5 Patient waiting room, Ruttonjee Hospital, Hong Kong Island East ClusterThe Journal of One Day Surgery | 99pain management have led to a shorter hospital stay andquicker recovery from surgery. More procedures willbecome suitable for day surgery. Ambulatory surgeryshould certainly be the trend in Hong Kong in the future,especially when the cost of medical care is escalating andthe number of hospital beds is limited.References1. Paper on Development of Ambulatory Surgery Service in theHospital Authority. 2. Chung HP, Tam YF, Cho SY. Day Surgery Centre, 2007 Annual Report,Department of Surgery, The University of Hong Kong, Tung WahHospitalAcknowledgementsWe are grateful to the contributions made to day surgery within HongKong by the following:• Department of Surgery, Alice Ho Miu Ling Nethersole Hospital,Northern District Hospital & Prince of Wales Hospital• Department of Surgery, Pamela Youde Nethersole Eastern Hospital• Department of Surgery, Ruttonjee Hospital• Department of Surgery, United Christian Hospital• Department of Surgery, Tung Wah Hospital & Queen Mary Hospital• Department of Surgery, Caritas Medical Centre, Kowloon WestCluster• Department of Surgery, Kwong Wah Hospital, Kowloon West Cluster• Working Group on Future Role and Development of Ambulatory /Day Surgery, Hospital Authority, HKSAREditorial AddendumTseung Kwan O Hospital, Hong KongDuring a recent visit to Hong Kong, the Editor wasprivileged to be invited to visit the Tseung Kwan OHospital in Kowloon. This modern facility (Figure 9)opened in 2000 and is the only acute general hospital in theTseung Kwan O and Sai Kung area, which has a localpopulation of about 400,000. The hospital had developedan Ambulatory Surgery Centre (ASC) as a multi-specialtycollaboration to provide services for general surgery,orthopaedics & trauma, gynaecology, otorhinolargngologyand ophthalmology.At the time of my visit, the ASU had three operating roomsand was open from 8 am to 8 pm. They were conductingabout 16 general anaesthesia cases per day in the variousspecialities, but the large and well equipped first (Figure 10)and second stage (Figure 11) recovery facilities couldclearly accommodate more patients than this. Asignificant proportion of the workload comprised minorFigure 6 Receptionist answering patient enquiries in the centre, Tung Wah Hospital,Hong Kong West ClusterFigure 7 Recovery bay, Tung Wah Hospital, Hong Kong West ClusterFigure 8 Patient receiving discharge notes from nursingstaff, Pamela Youde Nethersole Eastern Hospital, HongKong Island East ClusterFigure 9 The main entrance to the modern Tseung Kwan O Hospital, located on Po Ning Lane in Kowloon100 | The Journal of One Day Surgery | VOL 18 | No 4trauma, such as manipulation under anaesthesia offractured wrists. Somewhere between 50-100 of these wereperformed a year, with the procedure either completed onthe day of injury or, when a suitable theatre slot was notavailable, the patient was preassessed and given immediatecare with a date to return for definitive day surgery.A lot of attention had clearly been directed at preoperativeassessment and patient preparation. In addition to aconventional preassessment clinic, a number of patientswere selected to be seen in a Preanaesthetic AssessmentExpress (PACE) clinic, which was intended to streamlinethe process and reduce the number of return visits. Becauseof the limitations on capacity and variability of patientdemand, at the time of my visit, approximately half of allday case patients underwent telephone preassessment.Patients who were deemed suitable for day surgery or sameday admission at the surgical outpatient clinic underwent apreliminary screening with a questionnaire. They werethen given some information leaflets and details of thescreening program and gave consent for participating in thetelephone interview. These patients were subsequentlycontacted for telephone interview by a specially trainedanaesthetic nurse who assessed the patient using aspecially designed checklist for structured anaestheticassessment and patient education and counselling. Thewhole process was overseen by a specialist anaesthetistwho was available to answer queries and reviewed thecompleted assessment records. I also had a chance to viewa nicely prepared patient video, which provided a lot ofuseful information about likely anaesthetic techniques,especially the use of regional anaesthesia. These videoswere generally played while patients were waiting for theirindividual appointments.I would especially like to thank Cheng Hung-Kai,Consultant Anaesthetist and Chief of Service, Yung-YuNgai, the Ward Manager and Kathy Sim Foon, the daysurgery Nursing Sister and all the other people I met(Figure 12) during my brief visit to the Tseung Kwan OHospital. I am extremely grateful for their time and for thekind hospitality I received (Figure 13).Figure 10 The large first stage recovery unit equipped with modern trolleys. It is stillearly in the morning, but where are all the patients?Figure 11 The reclining chairs in second stage recovery were very new and luxurious,but I was assured that they were only a temporary arrangement until theelectrically-operated ones were delivered!Figure 12 The Editor with some of the staff of the Tseung Kwan O Ambulatorysurgery unitFigure 13 The egg tarts were a particular favourite of the former Governor, Chris Patton

Featured day surgery units: day surgery in Hong Kong

http://hub.hku.hk/bitstream/10722/59980/1/content.pdf

Featured day surgery units: day surgery in Hong Kong

Abstract

Similar works

Full text

Available Versions

HKU Scholars Hub