An ambulatory surgery service for women undergoing breast surgery has cut target times and saved money, as Jo Marsden and colleagues explain
Ambulatory breast cancer surgery - which means discharge on the same day or within 23 hours of surgery - is unusual in Europe but common in the US.
Recovery and mobility appear to be better than with inpatient admission, without any adverse psychological impact on women and their carers.
King's breast care unit developed clinical pathways in partnership with local community nurses to enable an ambulatory surgery service to be provided for women undergoing major breast surgery at King's College Hospital, London.
Eligible women are identified by pre-operative home assessments. A day surgery list dedicated to major breast surgery is scheduled every fortnight rather than weekly, owing to uncertainty about patient uptake of the service.
There are three tiers of post-operative care. First, there is a 24-hour, seven-day-a-week senior day surgery unit nurse bleeper-holder out of hours. Second, there is the clinical nurse specialist in breast care during office hours. Third, there is a community nurse telephone contact or home visit the day after discharge. This post-operative care plan is more comprehensive than the standard of care after inpatient admission.
Auditing the first six months of the service has shown that 44 per cent of women requiring mastectomy alone, or wide local excision with auxillary surgery, had ambulatory surgery.
This service has improved the quality of care, cut length of stay and reduced exposure to infection. The trust has benefited by expanding patient choice, improving target times and freeing up£250,000 per year. Following the initial success, we now have a weekly day surgery list, so our capacity will be doubled. -
Jo Marsden and Jonathan Roberts are consultant surgeons, and Terri Baxter is a clinical nurse specialist at King's College Hospital foundation trust.