DAY SURGERY “MY PERSONAL JOURNEY”
Bartholomeusz Hugh
Consultant Surgeon, Plastic & Reconstructive Surgery. Corrospondence:
Bartholomeusz Hugh, Chief Executive Officer, Tri Rhosen Day Hospital.
Secretary, Australian Day Surgery Council.
P.O. Box 1947, New Farm, Queensland, 4005, Australia.
Tel.: 61 7 32024744, Fax: 61 7 32810522, E-mail: hughb@bigpond.com.au
To cite this article:
Bartholomeusz Hugh. Day Surgery “ My Personal Journey”. Day Surg J India, 2008, 4:16-17
Paper received: December 2007. Accepted: February 2008. Source of support: Nil.

When I obtained my fellowship in Plastic and Reconstructive Surgery in 1984 the notion of Day Surgery did not exist. We were treating our multiple skin cancers under general anaesthesia with at least an overnight stay and all the big reconstructive procedures including Abdominoplasties, Breast Reductions and Facelifts were done in hospital with at least a three day stay. As my surgical practice developed in the Ipswich and West Moreton region, it became clear to me that a number of these procedures could be done as day cases. I therefore slowly converted all the skin cancer surgery to become day cases but I was unwilling to perform reconstructive procedures in day surgery for many years.

In 1995 it became obvious, to control my own surgical destiny, I should consider building a Day Procedure Centre. At that time in Australia there existed only 30 of such centres. These were mainly owned by surgeons and distributed in the capital cities of Brisbane, Sydney and Melbourne. I therefore designed and built a Day Procedure Centre consisting of consulting rooms and one theatre. This centre was designed to appear like the surrounding buildings with a “cottage” feel dating back to the architecture of the 1860’s. I was able to enact my personal attitude towards day surgery procedures. This involved treating patients in a dignified and homely manner with attention to detail of personalized quality service within a “state of the art” technological centre. Patients were given dressing gowns and pyjamas rather than the sterile hospital gowns, they were admitted only half an hour before their procedures and they were given thorough pre-operative and post-operative care instructions. All patients were rung on the day after surgery to ascertain that they were well, and understood their post-operative instructions.

In order to encourage my colleagues of various surgical

disciplines to participate in the Day Surgery Centre, I set up a legally constituted unit trust which would allow them to benefit from performing procedures at my centre. Slowly the centre grew from my involvement with an Ophthalmologist to include another Plastic Surgeon, a General Surgeon performing Endoscopy, Maxillofacial Surgeons, Urologists, and all Dental Practitioners who performed general anaesthesia procedures. My own experience expanded from simple multiple skin cancer excisions to involve all reconstructive procedures including Breast Reductions, Abdominoplasties, Liposuction, Facelifts, and some Breast Reconstructions. We were regulated by law to have written agreements from the local private and public hospitals to allow admission of any patients that were not suitable for discharge on the day of surgery. In the first five years of this operation the number of patients transferred to other facilities was only a staggering three. The centre had become accepted within the local region as the first multi-disciplinary day surgery and patients and medical practitioners alike chose the facility in preference to the local private hospital.

After ten years of operation and a throughput of approximately two thousand patients per year, the centre became too small for the increasing demand of surgical procedures. I therefore bought 700sq metres of freehold space within a local new medical centre and designed and built a new two theatre complex. Our challenge was to retain the homely atmosphere of our previous centre within what was now a very modern building. By using the same quality standards and “family” approach to our patients, we have been able to achieve this goal and have increased our surgical throughput.

During this time the number of day procedure centres has grown to over 270 freestanding units within Australia. Most of these centres are still owned by medical
ractitioners and they have varying profit sharing structures dependent upon the investment protocols of their surgeons. Most of the centres are in the capital cities and large regional centres. Some are multi-disciplinary but a number have been established specifically for disciplines such as Ophthalmology, Otolaryngology, Gastroenterology and Plastic and Reconstructive Surgery. All centres are financially viable and some, I believe, generate earnings before income tax of approximately 20% of their gross turnover. All centres must have a State Government license to operate and a Commonwealth Government provider number to enable them to be reimbursed by the Private Health Funds for procedures that are performed within their facility. Each centre must negotiate on a yearly basis with each of over twenty Private Health Funds operating within Australia. Approximately 50% of the Australian population are privately insured and, like other countries in the world, waiting lists for surgery at the public hospitals are exceedingly long. In this environment, even uninsured patients elect to pay for private day surgery treatment.

All centres have strict quality control guidelines and must be accredited by one of three agencies. The major agencies for accreditation are the ACHS (Australian Council for Healthcare Standards) and ISO9001 (International Standards Organisation for Day Surgery). To qualify for accreditation, surveys are conducted by both organisations at regular intervals and certificates of accreditation issued to each facility. As well as this, each state government performs their own licensing inspections on a regular basis and in some states, a Quality and Complaints Council has also been established. This council also requires regular data from each day procedure centre. The burden of all three regulators on the finances of each centre has become extraordinarily significant.
The peak body for day surgery management in Australia is the Australian Day Surgery Council. It has been legally constituted by the Royal Australasian College of Surgeons, Australian and New Zealand College of Anaesthetists, and the Australasian Society of Anaesthetists. A six member central committee is appointed by these bodies and it co-opts representatives from twenty other associations who
have an interest in day surgery. Foremost among these is the Australian Day Surgery Nurses Association and the Australian Day Hospital Association. The Australian Day Surgery Council elects two representatives to sit on the International Association of Ambulatory Surgery. Currently these representatives are Dr Lindsay Roberts and I. Lindsay has recently retired from the Executive Committee of the Association where he served two yearsas the International Association President. I have been recently elected onto the Executive and have also been chartered with the responsibility of being the President of the Organising Committee for the International Association of Ambulatory Surgery Conference in Brisbane in 2009. This is the first time that the conference has been held in the Southern Hemisphere.

When I reflect on my association with Day Surgery over the last twelve years, I am extremely humbled by the thought that I may have in some small way contributed to the success of Day Surgery within Australia. I see the future of Day Procedure Centres lying in extension toward 23 hour care and becoming teaching centres of excellence for medical and nursing undergraduates and surgical registrars. Because of the success of many individual day surgeries, it is my view that the corporate sector will begin to show an interest in acquiring these profitable centres. All in all, the future is certainly bright for Day Surgery in Australia.