A blueprint for day surgery

Historically, the surgeon to the Outpatient Department of the voluntary hospital had no access to inpatient beds, and unless he practised 'day surgery' he could not undertake surgical operations. Thus Nicholl' in 1909 was able to report a series of 9000 cases done in the outpatient department of the Glasgow Royal Hospital for Sick Children. Minor surgery has been undertaken for many years in casualty departments and outpatient departments and many surgeons have operated on day cases from their wards on routine inpatient operating lists. The real difference between these practices and day surgery now is that the latter is more highly organised, and the scope of work is more ambitious. Operating lists are devoted solely to day cases, and wards are staffed and run for these cases alone. It is a development which has taken place in the last two decades, and has been brought about because there is insufficient inpatient accommodation, which results in increased waiting lists (especially for minor surgery) and because of the progressive reduction in the hospital stay of patients and the earlier postoperative ambulation,2 which is again partially dictated by the pressure on bed occupancy, It will be apparent that other advantages and benefits flow from this method of management, but it cannot be denied that the original impetus for day surgery was an economic one. It is now rapidly becoming established as an accepted method of dealing with all minor (and much intermediate) elective surge~y,~-'O and it is rare in some hospitals to see these procedures done on routine inpatient operating lists. In one paediatric and neonatal surgical unit 50% of all operations are dealt with on a day basis." In due course, the scope of procedures undertaken will undoubtedly increase; much of the current surgical practice governing inpatient stay is still determined by tradition rather than necessity,6 and these practices may require radical reappraisal in the light of economic factors and scientific facts.'* There is a demand too from the public, now that many patients have experienced the convenience of day surgery, and the news media have publicised the benefits which accrue. In the United States of America the reasons for the adoption of day surgery have also been basically economic,13* l 4 but the demand has come from the patient, unable to meet the expense of prolonged hospitalisation, rather than from the surgeon. Where the State pays the bill, as in this country, the surgeon has taken the responsibility of making the most of the limited resources available to afford the best service to the greatest number. Public funds will always be inadequate to meet the needs in the field of Medicine, and this will be increasingly true in the future with the escalating costs of a progressively more sophisticated science. The role of economic projects such as day surgery will become more attrac-