Implementation of total laparoscopic hysterectomy as day case surgery

Area of Science:

• Gynaecological surgery
• Quality improvement in healthcare
• Patient safety and outcomes

Background:

• Elective surgeries are often cancelled in the National Health Service (NHS) due to inpatient bed shortages, exacerbated by emergency admissions and the COVID-19 pandemic.
• These cancellations impact surgical scheduling and patient access to care.

Purpose of the Study:

• To initiate and assess the feasibility and safety of a day case hysterectomy pathway.
• To improve the efficiency of elective gynaecological surgery by enabling same-day discharge.

Main Methods:

• A prospective data collection on selected, motivated patients undergoing hysterectomy.
• Implementation of interventions: preoperative education, hydration, modified anesthetic and surgical techniques, and enhanced collaboration between surgical and nursing teams.
• Phased implementation through change cycles to optimize the pathway.

Main Results:

• In the first change cycle, 93% of patients were discharged on the same day as their hysterectomy.
• In the second change cycle, 100% of patients achieved same-day discharge.
• A patient questionnaire revealed that 90% would recommend day case hysterectomy to others.

Conclusions:

• The day case hysterectomy pathway was successfully and safely introduced into the unit.
• Multidisciplinary team collaboration and leadership support were crucial for the pathway's initiation and rollout.
• This model provides a guideline for other gynaecological surgical teams within the trust.