How to alter surgical practice? The use of guidelines to encourage day-case haemorrhoidectomy.
BACKGROUND
Day case haemorrhoidectomy has been shown to be safe and acceptable to patients. The best way to introduce such evidence into clinical practice remains unclear: The aim is to assess the effectiveness of guidelines on the introduction of day-case haemorrhoidectomy in a general surgical unit.


METHODS
Prospective audit of day-case haemorrhoidectomy and retrospective review of in-patient procedures. The effectiveness of guidelines in encouraging day-case haemorrhoidectomy is assessed by analysis of avoidable admissions.


RESULTS
In the year prior to introduction of the guidelines 75 patients had elective haemorrhoidectomy, none as day-cases. In the year following the introduction of the guidelines 80 patients had elective haemorrhoidectomy, 35 (44%) as day cases. There were no complications or re-admissions. Of the 45 in-patients 31 (69%) were eligible for day surgery.


CONCLUSIONS
The establishment of clear guidelines and their dissemination results in significant changes in practice. However, audit has demonstrated that alternative strategies are needed to encourage changes in clinical practice.
Heer
R
R
Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
Dobson
D
D
Plusa
S M
SM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D017408:Guidelines as Topic; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012449:Safety