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How to alter surgical practice? The use of guidelines to encourage day-case haemorrhoidectomy
1Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
Insights
Implementing clear guidelines significantly increased day case haemorrhoidectomy rates. However, further strategies are needed to fully optimize this surgical practice for improved patient care and resource utilization.
Area of Science:
- Surgical Practice Innovation
- Clinical Guideline Implementation
- Healthcare Management
Background:
- Day case haemorrhoidectomy is a safe and patient-accepted procedure.
- Effective strategies for integrating day case haemorrhoidectomy into routine clinical practice are not well-defined.
- This study addresses the gap in understanding how to best implement evidence-based surgical practices.
Purpose of the Study:
- To evaluate the impact of clinical guidelines on the adoption of day case haemorrhoidectomy.
- To assess the effectiveness of a guideline-driven approach in a general surgical unit.
- To identify barriers and facilitators for implementing day case procedures.
Main Methods:
- Prospective audit of day case haemorrhoidectomy procedures.
- Retrospective review of inpatient haemorrhoidectomy cases.
- Analysis of avoidable admissions to measure guideline effectiveness.
Main Results:
- Prior to guideline implementation, no elective haemorrhoidectomies were performed as day cases.
- Following guideline introduction, 44% of elective haemorrhoidectomies were conducted as day cases.
- A significant proportion (69%) of initially inpatient cases were identified as suitable for day surgery, with no reported complications or re-admissions.
Conclusions:
- Clear guidelines and their dissemination can drive substantial changes in surgical practice.
- While guidelines initiate change, additional strategies are necessary to maximize the uptake of day case haemorrhoidectomy.
- Further interventions are required to overcome remaining barriers to efficient surgical care delivery.
Background:
Day case haemorrhoidectomy has been shown to be safe and acceptable to patients. The best way to introduce such evidence into clinical practice remains unclear: The aim is to assess the effectiveness of guidelines on the introduction of day-case haemorrhoidectomy in a general surgical unit.
Methods:
Prospective audit of day-case haemorrhoidectomy and retrospective review of in-patient procedures. The effectiveness of guidelines in encouraging day-case haemorrhoidectomy is assessed by analysis of avoidable admissions.
Results:
In the year prior to introduction of the guidelines 75 patients had elective haemorrhoidectomy, none as day-cases. In the year following the introduction of the guidelines 80 patients had elective haemorrhoidectomy, 35 (44%) as day cases. There were no complications or re-admissions. Of the 45 in-patients 31 (69%) were eligible for day surgery.
Conclusions:
The establishment of clear guidelines and their dissemination results in significant changes in practice. However, audit has demonstrated that alternative strategies are needed to encourage changes in clinical practice.