title: Day of surgery admission for the elective surgical in-patient: successful implementation of the Elective Surgery Programme.
abstract: OBJECTIVE
  The aim of this prospective cross-sectional study was to determine the impact of (1) ring fencing in-patient general surgical beds and (2) introducing a pre-operative assessment clinic (PAC) on the day of surgery admission (DOSA) rate in a single Irish institution. The secondary aim was to analyse the impact of an increased rate of DOSA on cost efficiency and patient satisfaction.
  
  
  METHODS
  An 18-month period was examined following ring-fencing of elective and emergency surgical beds. A PAC was established during the study period. Prospectively collected data pertaining to all surgical admissions were retrieved using patient administration system software (Powerterm Pro, Eircom Software) and a database of performance information from Irish Public Health Services (HealthStat).
  
  
  RESULTS
  Ring-fencing and PAC establishment was associated with a significant increase in the overall DOSA rate from 56 to 85%, surpassing the national target rate of DOSA (75%). Data relating specifically to general surgery admissions mirrored this increase in DOSA rate from a median of 5 patients per month, before the advent of ring-fencing and PAC, to 42 patients per month (p < 0.0387). 100 patient surveys demonstrated high levels of satisfaction with DOSA, with a preference compared to admission one night pre-operatively. Cost analysis demonstrated overall savings of 340,370 Euro from this change in practice.
  
  
  CONCLUSIONS
  The present study supports the practice of DOSA through the introduction of ring-fenced surgical beds and PAC. This has been shown to improve hospital resource utilisation and streamline surgical service provision in these economically challenging times.
authors.affiliation: Department of Surgery, Mayo General Hospital, Castlebar, County Mayo, Ireland. lizconcannon@gmail.com
authors.forename: E S
authors.initials: ES
authors.lastname: Concannon
authors.forename: A M
authors.initials: AM
authors.lastname: Hogan
authors.forename: L
authors.initials: L
authors.lastname: Flood
authors.forename: W
authors.initials: W
authors.lastname: Khan
authors.forename: R
authors.initials: R
authors.lastname: Waldron
authors.forename: K
authors.initials: K
authors.lastname: Barry
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D004526:Efficiency; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D006295:Health Resources; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D015397:Program Evaluation; D011446:Prospective Studies