Increase in day case surgery would improve care for ear, nose and throat patients

Patients, clinicians and trusts to benefit from latest GIRFT recommendations

Both patients and hospital trusts will benefit if more ear, nose and throat (ENT) surgery in England is carried out as a day case, according to the latest national report from the Getting It Right First Time (GIRFT) programme.

The GIRFT review of ENT services visited 126 units across the country and found that thousands more people could be treated on a day case basis rather than having an overnight stay in hospital. Through a series of recommendations and by sharing the good practice of units with higher-than-average day case rates, GIRFT aims to:

  • ensure more patients are treated without the worry or inconvenience of a stay in hospital;
  • make ENT departments more resilient to pressures on beds;
  • allow trusts to free up beds for use by other specialties.

As well as enabling patients to get home more quickly, increasing day case rates for tonsillectomy operations could release between £1.4m and £3.7m per year for the NHS.

Click here to download a copy of the report

The GIRFT report on ear, nose and throat (ENT) surgery is the ninth national report from the Getting It Right First Time programme. It shows there are 330,000 admissions to ENT departments every year, with 43,000 children and adults admitted for the most common procedure of tonsillectomy. There are also 2.8 million ENT outpatient attendances, including 960,000 outpatient procedures.

The report – written by Mr Andrew Marshall, a consultant ENT surgeon at Nottingham University Hospitals NHS Trust – makes 23 recommendations designed to improve the experience for millions of patients every year by lowering the number of admissions and repeat visits and potentially reducing waiting times.

He said: “There is a huge opportunity for more of the national ENT caseload to be treated on a day case basis if the right facilities and working practices can be put in place. Increasing the use of day case treatment in ENT would benefit patients as well as ENT units and their trusts, making units more resilient to pressures on beds and allowing hospitals to free up beds for other people.

“I have seen some remarkable work being done in ENT units across the country as I have carried out visits for this review. I hope the good practice case studies in the report and my recommendations help to bring about improvements which will make life better both for the NHS staff who work so hard and for the patients, who deserve the best possible care at all times.”

Suggested actions aimed at increasing day case rates include trusts having a dedicated day case unit or bed where possible, reviewing administrative processes to ensure patients can be listed as a day case, prioritising cases to morning or early afternoon theatre lists, and carrying out capacity planning.

Recommendations in the report also look at reducing the number of on-the-day cancellations for patients needing surgery. The total estimated cost of ENT surgery cancellations (elective in-patient and day case) is around £5m per year. Operations are sometimes cancelled because the patient’s medical condition and co-morbidity have changed between the time of pre-assessment and their admission date. GIRFT has identified potential savings of between £610,000 and £1.4m if trusts adopt best practice measures to minimise these cancellations.

Overall, the report identifies potential cost efficiencies of between £21.7m and £30.8m per year. If all trusts met the national average for adult outpatient follow-up rates, around 114,000 fewer appointments would be needed, freeing up £10m to use elsewhere; and if trusts reduced paediatric outpatient follow-up rates to the national average there would be 35,000 fewer appointments, freeing up £3m.

A further recommendation addresses how consultant time can be freed up to see more patients by making greater use of specialist nurses and other professionals for follow-up patients after routine surgery.

Mr Marshall says in his report: “We believe there is a significant opportunity to use consultant outpatient time more effectively by making better use of skill mix. There are opportunities for the wider multidisciplinary team, including specialist nurses and allied health professionals, to play a significant role in the delivery of ENT services.”

The GIRFT report is endorsed by ENT UK, the British association of otorhinolaryngology. President Professor Nirmal Kumar said: “This report shows there is very good work being done in ENT departments across the country.

“The findings offer great scope to build on the strong foundations of service already in place, in terms of quality of patient care and the sheer volume of savings that the NHS could invest back into patient services.”

Commenting on the report, Royal College of Surgeons (RCS) council member, Mr Timothy Mitchell, said: These are welcome recommendations which shine a light on the potential to save patients the trauma and trouble of overnight stays in hospital, and to save the NHS money in the process.

“There is a crisis across the NHS with operations being cancelled because of a shortage of beds and a shortage of staff.

“If more ENT procedures can be undertaken without need of an in-patient bed, that will free up capacity for other critical operations, improving patient care overall.”

5 November 2019