Sunday 19 November 2017

Day care surgeries can save hospitals millions

Eilish O'Regan Health Correspondent

THOUSANDS of patients are being admitted overnight to scarce hospital beds for treatments that could be done at a fraction of the cost if they were operated on and sent home on the same day, according to the HSE.

Figures seen by the Irish Independent reveal the huge savings possible for cash-strapped hospitals when a patient is treated on a day-care basis.

Medical advances mean the traditional system of keeping a patient in hospital for a number of days is no longer needed for a growing number of surgeries, treatments and scans.

A patient who has their appendix removed on a day-care basis -- going home after the surgery -- can cost a hospital €2,044.

But a similar patient, without any complications, who is admitted to a hospital bed before and after the operation, costs €4,497.

Leading vascular surgeon Professor Sean Tierney said last night it was only relatively recently that hospitals had been able to do a large volume of day-care surgeries safely.

But he said doctors had been pushing for the expansion of day-care surgery.

For example, a hernia operation on a day-care basis costs just €1,496 -- but the price shoots up to €3,618 if the patient is admitted to a hospital bed.

A hysterectomy, involving the removal of a woman's womb, can be done on a day-case basis for €2,618 -- but it is as high as €6,748 once the patient has a stay in hospital.

The HSE has a "basket" of 24 procedures that can be carried out without admitting a patient to hospital -- and says hospitals should be doing three-quarters of these on a day-care basis.

However, the success rate for meeting the target varies.

For instance, a snapshot of February figures shows Cork University Hospital did just 60pc of cataract removals on a day-care basis.

Meanwhile, Mullingar Hospital managed a rate of just 55pc for varicose vein operations.

Prices

The average differences in costs are revealed in the HSE's "ready reckoner" of average inpatient and day-case prices, which has been sent to all hospitals.

The benefit of a day-care treatment for the patient is that it is quick and convenient and they return home hours later, reducing their exposure to hospital bugs.

Although not all procedures or patients -- due to their state of health or age -- are suitable for day care, the HSE's own figures for the average price of identical day and inpatient treatments show how they are cost effective.

Hospitals are treating more patients, including those undergoing operations, on a day-care basis -- up from 314,971 in 2001 to 857,596 in 2010.

Prof Tierney, a surgeon in Tallaght Hospital, said it required a high level of organisation to ensure day procedures were done safely and the patient underwent full pre-assessment.

"Patients must be safely assessed before the surgery and the whole thing must be very well organised," he told the Irish Independent.

"This surgery is not just cost effective but it can reduce the risk of patient complications, like hospital infection."

He explained that the pre-assessment could involve blood tests, X-rays or other scans.

"You need anaesthetic, nursing and medical staff who are assigned to this work on a regular basis so that is a patient is not suitable it is flagged and a problem is resolved.

"Everyone needs to get the same high standard of care," he added.

"Once patients have it explained to them, and they understand, they don't have a problem with day surgery and it can improve their outcomes.

"We have been doing day surgery in Tallaght for a long time and operating on patients with varicose veins in this way since 1999.

"It is easier to plan in some specialties more than others and it does not work well with emergency surgery."

The HSE price list also reveals that a heart transplant is the most expensive operation performed in hospital, costing €186,813. A liver transplant is the next most expensive at €126,404.

The national average bill for a patient admitted to hospital is €5,217 while it comes to €703 for someone treated on a day basis.

Irish Independent

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