Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

224
Appendix 19
• patients aged over 18 years undergoing
general, orthopaedic or gynaecological day
surgery (adults)
• patients aged between 3 and 12 years
undergoing general or ENT day surgery
(paediatrics).
Study sample
The staff resource use study sample included all
patients recruited into the main study in October
and November 2000.
Analysis
An Excel 97 ® spreadsheet was used to record and
analyse the data. Descriptive statistics (mean and
95% CIs) were calculated for the semi-fixed costs
associated with each surgical group and study site.
Results
The stages of the day-surgery episode were
confirmed during patient recruitment for the
main study and four face-to-face interviews with
nursing staff who cared for day patients at the
NHS trust study sites (Figure 34). Four interviews
with nursing staff from each hospital ward who
cared for recruited patients determined the
grade of staff and time taken to complete the
component tasks of a day-surgery episode,
excluding the anaesthetic room and operating
theatre. The grade of staff and time to complete
tasks was consistent between the study sites, but
varied between adult and paediatric patients.
The average semi-fixed cost per minute for the
component tasks of the day-surgery episode
was calculated for adult and paediatric patients
(Table 92). The most notable difference between
adult and paediatric levels of care for a day-surgery
episode occurred during postoperative monitoring
on the ward. Paediatric patients had dedicated
care from one nurse for 2 hours, but one nurse
would be expected to care for more than one
adult patient.
One-hundred and ninety-four day procedures
for recruited patients were directly observed in
the anaesthetic room and operating theatre of
the main study NHS trust sites. Differences in
working practices in terms of skill mix were
observed between the three hospital sites, but
Patient arrives on the ward
Patient is admitted to the ward
Patient arrives in theatre reception
Patient arrives in anaesthetic room
Patient arrives in theatre
Patient is taken to theatre
Patient is transferred to anaesthetic room
Patient is transferred to theatre
Patient arrives in recovery room
Patient is monitored on ward
Patient is discharged
Patient is transferred to recovery room
Patient is returned to ward
Patient leaves to go home
FIGURE 34 The stages of the day-surgery episode
this did not translate into notable differences (the
95% CIs overlap) in the average semi-fixed costs.
There was a detectable difference between the
average semi-fixed costs of providing care in the
anaesthetic room and operating theatre for adult
and paediatric day surgery (Table 93).
Implications for the main study
This staff resource use study detected differences
in the semi-fixed costs per minute for adult and
paediatric practice. These semi-fixed costs per
minute for each stage of the day-surgery episode
were used to calculate the total cost in each arm
of the adult and paediatric study, respectively.