What is the recommended number of procedures and patients per clinic day?

Recommended Number of Procedures and Patients per Clinic Day

The target for day surgery procedures should be 75% of all elective surgeries, with an emphasis on maximizing the number of procedures while maintaining quality care and patient safety. 1

Current Guidelines and Targets

The Association of Anaesthetists and the British Association of Day Surgery recommend that day surgery should be considered the default option for most surgical procedures. This approach has been endorsed by multiple organizations:

• The Academy of Medical Royal Colleges' "Choosing Wisely" initiative made day surgery their top recommendation for clinicians 1
• The NHS target is that 75% of elective surgeries should be performed as day cases 1
• Even higher rates may be possible with advances in minimally invasive techniques 1

Factors Affecting Daily Procedure Volume

Patient Selection Considerations

Patient selection for day surgery should be based on:

1. Medical factors:

   • ASA status (patients with ASA 3 and 4 have higher risk of complications but can still be considered for day surgery with appropriate planning) 1
   • Age (patients >85 years have significantly higher risk of postoperative delirium) 1
   • BMI (underweight patients have higher complication risks) 1

2. Surgical factors:

   • Procedure type and complexity
   • Expected operation time (longer operations correlate with higher complication rates) 1
   • Anticipated postoperative care needs

3. Social factors:

   • Patient understanding of the procedure
   • Availability of an escort home
   • Post-discharge support requirements 1

Operational Efficiency Factors

To maximize the number of procedures while maintaining quality:

• Implement effective pre-anesthetic assessment and preparation 1
• Utilize protocol-driven nurse-led discharge processes 1
• Consider procedure-specific targets as outlined by the British Association of Day Surgery 1
• Develop standardized patient pathways for common procedures 1

Specific Recommendations for Clinic Scheduling

Based on the available evidence, an optimal approach would include:

1. Procedure scheduling:

   • Schedule complex procedures earlier in the day to allow adequate recovery time
   • Group similar procedures together to improve efficiency
   • Account for "bridging times" between patients to prevent overcrowding of waiting areas 2

2. Patient flow management:

   • Implement same-day scheduling where appropriate to reduce waiting times 3
   • Consider open access or direct booking/referral systems for appropriate procedures 3
   • Use telemedicine for pre-assessment and follow-up to reduce in-person visits 4

Common Pitfalls and How to Avoid Them

1. Overcrowding of waiting areas:

   • Design blueprint schedules that account for COVID-19 or other distancing measures 2
   • Consider a mix of in-person (87-88%) and digital (12-13%) appointments 2

2. High rates of missed appointments:

   • Implement patient engagement programs to reduce no-show rates 5
   • Educate patients about the importance of keeping appointments

3. Inefficient use of operating room time:

   • Use goal programming models to minimize idle time and overtime 6
   • Sort requests based on block restrictions, room utilization, and surgeon preferences 6

4. Inadequate patient preparation:

   • Ensure thorough pre-operative assessment
   • Provide clear instructions for preparation and post-operative care

While the specific number of procedures and patients per clinic day will vary based on specialty, procedure complexity, and facility resources, the goal should be to maximize throughput while maintaining the 75% day surgery target for elective procedures. This requires careful planning of patient flow, efficient use of resources, and appropriate patient selection.