Day care services of a hospital and its management

Day care

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Madhuri Kolhapure
M.Sc. H.A.

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What is day care ?
A concept in health care delivery by which a
patient is admitted to a hospital for a few hours
for a prescheduled surgery or for an invasive or
high risk diagnostic /treatment procedure
Patient requires post operative care after surgery
hence is kept under nursing care
Such a patient is not considered in the in-patient
census
The length of hospitalization is less than one day

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Benefits of day care
Minimizes disruption to the normal lives of patient
and their families.
Avoids the disruption associated with
hospitalization , especially in children.
Decreases the procedure waiting period particularly
if the delay is linked to long waiting lists consequent
to bed shortage.
Lowers the risk of nosocomial infection.
Reduces the bill
Effective utilization of resources.
Reduces hospital expenditure in government
hospital.
Profit making area

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Organization for day care

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Mixing day care patient with inpatients
This system involves utilizing
inpatient beds in wards of various specialties
for day care patient admitted to the respective
specialties .

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Facilities of day care unit
Located close to the operation theater designated
for day care surgery
The theater should be equipped for performing
common operations
Should be equipped to handle emergencies and
complications of surgery if at all required

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Patient selection
Patient should be fit for surgery
Patients with uncontrolled diabetes and chronic
respiratory and cardiac diseases should be
excluded
Patients who are obese should be excluded
Patients less than 6 months and elderly more
than 65 yrs should be excluded
Pre anesthetic clearance should be obtained in
advance for patients requiring general
anesthesia

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Pre procedure advice to patients
Patient should have been advised regarding the
surgery and the risks associated with it
Informed consent should be obtained for the
surgery
If the patient wishes to cancel the procedure he
should inform the hospital or the surgeon 48
hours in advance

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Responsibilities of the day care
staff
Once the patient reports to the day care facility it is
the responsibility of the staff to verify if the patient
has followed the instructions given to him prior to
hospitalization
The patient and the procedure site is then prepared
and special instructions if any complied with
Following the procedure the day care staff is
responsible for providing nursing care and
complying with post operative instructions as
directed by the clinician

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Discharge and post operative
instructions
Stable vital signs
Alert ,oriented
Comfortable and pain free
Should be able to walk unassisted and dress
independently
Able to tolerate oral fluids and have min nausea and
vomiting
Should be accompanied with a responsible adult
Patients who develop complications are not fit for
discharge
At the time of discharge post operative medication and
instructions are given to the patient

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Management issues
The day care unit is usually headed by a senior
clinician
He monitors the average number of patients per
day
Average number of surgeries performed in a day
Percentage of day care patients who cannot be
discharged following surgery
Nonattendance rate
Patient satisfaction and feed back from the
patients

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