Introduction

Heatherwood is a stand-alone elective hub. The type of surgical procedures that can be safely delivered in this environment are limited by several factors and must be considered at the time of booking.

The following criteria help identify procedures which are not suitable to be performed at Heatherwood. This is not an exhaustive list and if there is doubt about an individual case, a second opinion should be sought by contacting one of the consultant anaesthetists responsible for pre-operative assessment at Heatherwood.

This guidance should be considered alongside the Heatherwood hospital admission guidelines for surgery in theatres.

Surgery-related factors

Planned laparotomy or mini-laparotomy

Planned bowel resections

Vascular cases involving arterial work

No appropriate pathway available for back up assistance in the event of a complication

May require interventional radiology

Potential risk of bleeding that may require blood transfusion (there is limited access to blood onsite) e.g. surgery for fibroids

Post-operative care requirements

May require level 2 or 3 critical care post-operatively

May require enhanced care (level 1.5) in PACU overnight

May require specialist nursing after-care

Anticipated pain management issues e.g. opioid dependency, chronic pain

Anticipated delay in recovery phase due to social or mobility issues

Medical factors

Refer to Heatherwood hospital admission guidelines for surgery in theatres

Exceptional circumstances

In exceptional circumstances, a case which does not meet the above criteria may be considered to proceed at Heatherwood where there are clear patient benefits. In this event, the case must be discussed in advance of booking with the relevant COS for the surgical speciality and anaesthetic COS or deputy COS. Care must be delivered by a senior surgical and anaesthetic team. The theatre team must also be informed in advance to ensure any specialist kit is available. It is the responsibility of the operating surgeon to ensure all these processes have been completed.

Introduction of new surgical procedures at Heatherwood

The above factors must be considered, but in addition the surgical team must address the following issues

• GIRFT compliant patient pathway ratified by their directorate clinical governance group and anaesthetic clinical governance

• Aim to deliver surgical care as day case surgery, in accordance with BADS procedure specific day case targets

• Adequate training of theatre and ward staff

• Provision of specialised equipment required in theatre or for aftercare

• Any specific peri-operative patient instructions to be delivered eg pre-op instructions and discharge information

• Specific drugs required peri-operatively, especially as TTAs

• Safety netting process to enable safe discharge as day case eg telephone follow up and clear escalation plan including contact numbers for out of hours advice

• Arrangements for imaging e.g. intra- or post-op X-ray

• Can this procedure be safely delivered on Saturdays?

All the above information must be provided to the Heatherwood elective steering group prior to introduction of the service to ensure teams have time to prepare to deliver care safely. The GIRFT surgical speciality leads are best placed to lead and co-ordinate this process or delegate to a named individual.

Reference material

Model of Care for Elective Surgery Royal College of Surgeons Ireland

Providing quality care for women - Standards for gynaecology care Royal College of Obstetricians and Gynaecologists 2016

British Association of Day Surgery (BADS) directory of procedures and national dataset

Heatherwood hospital admission guidelines for surgery in theatres