Direct access surgery

Evolving surgical practice in the UK is imposing increasing pressures on surgical outpatient clinics. A Direct Access Surgery (DAS) programme was evaluated in which otherwise healthy patients with simple surgical conditions presenting little diagnostic difficulty were referred directly to hospital for surgical operation without attending the outpatient department. Specific referral criteria for DAS were devised. Appropriate surgical conditions or procedures included hernias, vasectomies, cystic scrotal swellings, subcutaneous lumps and skin lesions, symptomatic gallstones, varicose veins and ingrowing toenails. Over a 12 month period, 105 patients were referred for DAS and 102 underwent operation. There was a low incidence of inaccurate diagnosis (< 2%) and inappropriate referral (< 1%). DAS was well received by both General Practitioners (GPs) and patients. Implementation of such programmes may result in considerable savings of outpatient time and resources.