Abstract Aim Laparoscopic cholecystectomy (LC) is the gold standard management for symptomatic gallstone disease and is usually performed as a day case. A Getting it Right First Time (GIRFT) analysis at our institution highlighted a decline in the rate of day-case elective LC. This prompted an audit and subsequent quality improvement initiative. Methods We analysed patient data for elective LC between October 2023 and February 2024. Analysis identified areas for improvement, leading to the development of a business case and implementation of two interventions. First, the day surgery unit (DSU) recovery’s operational hours were extended to 9 PM. Second, the local anaesthetic (LA) protocol during LC was modified. In addition to port sites, LA was also infiltrated into the liver bed, thereby improving postoperative pain control and early mobilization. Following this, a re-audit was conducted between March and August 2024. Results Initial data from 86 elective LCs between October 2023 and February 2024 revealed a day-case rate of 64% (55/86), above the national median of 60%. The primary reasons for unplanned admissions were DSU closing at 6 PM, intraoperative concerns and post-operative pain. As per NHS national tariff 2024/25, the cost of unplanned admissions (median 1 day) was approximately £12,000. Our re-audit encompassing 101 elective LCs demonstrated an increase in our day-case rate to 73% (74/101). Conclusion This data suggests that extending DSU hours and optimizing LA techniques can positively impact day case rates. These findings have implications for resource utilization, reducing inpatient bed occupancy, associated costs and improved patient satisfaction through reduced hospital stays.
Kumaran et al. (Fri,) studied this question.
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