Abstract: How to alter surgical practice? The use of guidelines to encourage day-case haemorrhoidectomy.

Authors:

Heer R, Dobson D, Plusa SM.

Institution:

Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.

Source:

J R Coll Surg Edinb. 2000 Dec;45(6):369-70.

Abstract:

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.

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