Elective ambulatory surgical care in Ireland—why it needs to be better coded, classified and managed

Background In the year to July 2017, surgical disciplines accounted for 73% of the total national inpatient and day case waiting list and, of these, day cases accounted for 72%. Their proper classification is therefore important so that patients can be managed and treated in the most suitable and ef...

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Bibliographic Details
Published in:Irish journal of medical science 2018-08, Vol.187 (3), p.747-754
Main Authors: Keane, Frank, Hammond, Laura, Kelliher, Gerry, Mealy, Ken
Format: Article
Language:English
Subjects:
Family Medicine
General Practice
Internal Medicine
Medicine
Medicine & Public Health
Original Article
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Summary:Background In the year to July 2017, surgical disciplines accounted for 73% of the total national inpatient and day case waiting list and, of these, day cases accounted for 72%. Their proper classification is therefore important so that patients can be managed and treated in the most suitable and efficient setting. Aims We set out to sub-classify the different elective surgical day cases treated in Irish public hospitals in order to assess their need to be managed as day cases and the consistency of practice between hospitals. Methods We analysed all elective day cases that came under the care of surgeons between January 2014 and December 2016 and sub-classified them into those that were (A) true day case surgical procedures; (B) minor surgery or outpatient procedures; (C) gastrointestinal endoscopies; (D) day case, non-surgical interventions and (E) unclassified or having no primary procedure identified. Results Of 813,236 day case surgical interventions performed over 3 years, 26% were adjudged to accord with group A, 41% with B, 23% with C, 5% with D and 5% with E. The ratio of A to B procedures did not vary significantly across the range of hospital types. However, there were some notable variations in coding and practices between hospitals. Conclusion Our findings show that many day cases should have been performed as outpatient procedures and that there were variations in coding and practices between hospitals that could not be easily explained. Outpatient procedure coding and a better, more consistent, classification of day cases are both required to better manage this group of patients.
ISSN:0021-1265
1863-4362
DOI:10.1007/s11845-017-1726-5