title: The evolution of a hand day-surgery unit.
abstract: BACKGROUND
  Following the merger of two major units to form a regional centre for plastic surgery in the West Midlands, acute hand surgery referrals reached overwhelming proportions. This study describes audits performed at three time points. The first highlighted the extent of in-patient delay and was instrumental in the subsequent development of a dedicated hand trauma day-case unit.
  
  
  METHODS
  Data were collected on 77 patients in June 2002, 109 patients in November 2003 and 90 patients in November 2004. The day-case unit opened on 1 November 2003.
  
  
  RESULTS
  The number of bed-days per patient fell from 2.63 to 1.34 (P < 0.001) over the study period. In November 2004, 51% of patients received a day-case procedure. Importantly, if admission was required at initial presentation, the delay to theatre reduced from 1.5 bed-days per patient in June 2002 to 0.6 in November 2004. Overall, the in-patient delay was significantly reduced (P < 0.001) but time from presentation to theatre was not significantly affected (P = 0.119).
  
  
  CONCLUSIONS
  This series of audits confirmed that a significant number of acute hand injuries are suitable for day-case procedures and that simple audit can lead to a significant change in service provision. Improvements were demonstrated in reduced in-patient delay and total stay. We hope that other units find our experience useful given that it may be possible to apply this approach to other forms of ambulatory trauma.
authors.affiliation: Department of Plastic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK. cathryndillon@hotmail.com
authors.forename: C K
authors.initials: CK
authors.lastname: Dillon
authors.forename: D L
authors.initials: DL
authors.lastname: Chester
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: O G
authors.initials: OG
authors.lastname: Titley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D000556:Ambulatory Surgical Procedures / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000592:standards; D014850:Waiting Lists; D055815:Young Adult
references.citation: Ann R Coll Surg Engl. 2003 Jan;85(1):28-31
references.pmid: 12585628
references.citation: J Otolaryngol. 2006 Aug;35(4):235-41
references.pmid: 17176798
references.citation: Singapore Med J. 2002 Oct;43(10):522-6
references.pmid: 12587707
references.citation: Ann R Coll Surg Engl. 2005 Nov;87(6):466-8
references.pmid: 16263020
references.citation: Int J Nurs Pract. 2006 Aug;12(4):178-92
references.pmid: 16834578
references.citation: J Hand Surg Br. 2004 Dec;29(6):575-9
references.pmid: 15542219
references.citation: J Hand Surg Br. 2004 Oct;29(5):458-60
references.pmid: 15336749