Day surgery rates increase but still behind target

Day surgery admission rates increased to 77% during the year to date but still fall short of the HSE’s target of 85% across all hospitals, the Public Accounts Committee heard yesterday.

National director of the HSE’s national acute hospitals division, Dr Tony O’Connell, said the number of day cases, at 41,500 for the year to date, was for 24 procedures.

Dr O’Connell said they were “more rigorously” managing surgery performance in hospitals.

“The HSE has developed and expanded its range of surgery indicators and will include these in it 2015 National Service Plan.”

Labour’s Derek Nolan said just 10% of tonsillectomies were undertaken as a day case, compared to Britain’s day case rate of 40% for the same procedure.

The HSE’s clinical programme lead for the surgery programme, Prof Frank Keane, said some consultants were still uncomfortable about undertaking tonsillectomies on a day case basis.

They had been visiting hospitals and showing data so they could see how well or badly they were performing on surgical day cases.

Prof Keane said they were aware that Cork University Hospital was “behind the line” on the removal of cataracts as a day case procedure.

Because of the way the hospital was set up, it was not safe to do the surgery on a day case basis and that was being remedied.

Dr O’Connell said hospitals were effectively being penalised financially because they were appropriately assigning cases for day surgery — their income was based on the number of in-patients.

“We do have to overcome these perverse financial incentives to make sure that what is clinically right for the patient is reflected in an appropriate financial reimbursement.”

Prof Keane said they also reckoned that up to 30% of day case procedures could be undertaken in a GP’s survey.

Mr Nolan said there appeared to be a financial incentive for hospitals to bring patients in as a day case for minor procedures.

“With the current funding there isn’t a disincentive not to,” said Prof Keane. He had met with GPs to discuss how some of the surgery could be moved out of acute hospitals and into primary care.

The Comptroller and Auditor General, Seamus McCarthy, said only one hospital in five reported that they monitor the rate of patients deemed to be unsuitable for day surgery.

He said good practice models suggested that for optimum efficiency, day surgery should ideally be provided in a self-contained unit with specially trained staff.

However, hospitals reported that just 10% of operating theatres were dedicated to day surgery.


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