here is a perpetual shortage of beds in hospitals, particularly in government hospitals, where the majority of the patients seek admission. Although new hospitals are being started and more beds are being added in the existing hospitals, there are long waiting lists in every government or charity centre. It is not uncommon to see a patient making multiple trips to a hospital to seek admission. He fails to do so, gets frustrated and ultimately gives up the idea of getting admitted only to land up in the hospital as an emergency case. He may start visiting the hospital again when the condition becomes worse as in cancer.
This is not a problem unique to India. It is being faced by almost all the developing countries. The developed countries have already faced it and come up with the idea of day-care surgery, also known as outpatient surgery or short-stay surgery.
Day-care surgery has been known for a long time. This means that the patients spend only a few hours in the hospital after the operation and are subsequently sent home. But the concept has been implemented on a larger scale over the past 10 years only.
Dr Sujit Pandit, Professor of Anesthesia from Ann Arbor, University of Michigan, delivered an informative lecture at the PGI recently and I would like to share the interesting points in it and the crux of the lively deliberations that it generated.
About a decade back, only 10 per cent of surgical operations were done as day-care procedures, but over the years it has become such a successful venture that almost 50 per cent of 37 million operations performed in the USA every year are now being carried out as day-care procedures. More and more major operations are being included in this programme.
The advantages or day-care surgery are many. Some of these are mentioned below:
- Prevention of cross infection to the patient from the hospital’s atmosphere and other patients.
- Sparing the much-needed hospital beds for seriously ill patients who require hospitalisation and close monitoring.
- Sparing the doctors and the nurses the burden of monitoring very sick patients.
- Cutting down the expenses. Health-care has become a very costly affair. In the USA an average hospital bed costs $600 per day and in India it may cost Rs 500 to Rs 5000 a day in a good nursing home. Even the PGI charges about Rs 1000 for a bed only. Other charges are inescapable.
- Psychologically, the patient and his relations feel happy to go back home and recover in their known environment.
- The inconvenience to the patients and their relations are minimised.
But all said and done, the implementation of any new system requires planning, infrastructure and proper execution; success is achieved only if periodic evaluation is carried out, followed by the required restructuring and modification.
Here are some of the basic requirements for day-care surgery.
- The patient should be thoroughly examined in the outpatient department, not only about his present illness but also to evaluate his suitability for undergoing anesthesia and the operation.
- All the relevant investigations must be carried out as outpatient tests.
- Facilities must exist to receive the patient in the operation theatre complex at least three hours before the operation.
- Pre-operative steps liked the change of clothes, the preparation of the part to be operated upon, the administration of premedication, the attestation of the consent form and other formalities have to be gone through before the operation.
- Facilities must exist to keep the patient in the post-operative ward till he comes out completely of anaesthesia and is able to travel to his residence.
- The hospital facilities should be available round the clock so that the operated patient can be cared for promptly if he develops any problem.
- Communication facilities are most necessary.
- Arrangement should be made for a doctor or a nurse to visit the patient at home at night for evaluation and advice — particularly for pain relief, the administration of antibiotics, etc.
- It is desirable that the patient should stay within a radius of 20 to 25 km from the hospital.
- The patient should be given complete instructions at the time of discharge.
I am of the opinion that the most important factor is the establishment of mutual trust between the patient and the operating team.
The PGI has been undertaking day-care surgery in a small way and it is likely to get a big boost with the opening of the new OPD complex where day-care surgery has been planned with six operation theatres and various facilities. But we shall have to move cautiously and progress slowly but steadily to make this a successful venture. A multidisciplinary approach and proper organisation are the key to success in this field.
More light on breast cancer BY DR.S.M.BOSE
Breast cancer is the second most common form of cancer affecting women in India. There has been a steady rise in its incidence. It is affecting Indian women at a much younger age as compared to those in the West. Obviously, the disease here is seen at an advanced stage.
The management of breast cancer is controversial. The confusion is multiplied as there is no recommended standard management protocol for the disease in India. To eliminate this lacunae, Prof S.M. Bose of the PGI, who has written the article on day-care surgery, has brought out a book, “Consensus on Breast Cancer” which covers all aspects of the disease, right from classification to follow-up.
The contributors to the book are eminent medical persons interested in the subject.
The volume was released during the inaugural function of the International Breast Cancer Conference held at Nagpur recently.
Dr Bose, the eminent cancer surgeon, received the prestigious Dr B.C. Roy National Award for Eminent Medical Teacher last year. His popular book titled “Cancer”, published by the Government of India and written for the health education of the people, has been translated into many languages. The specialist has also been elected a Fellow of the National Academy of Medical Sciences.