Phaholpolpayuhasaena Hospital: The original “One Day Surgery”
One Day Surgery (ODS) has been well-established in the medical field for quite a while, but it was only recently, after the Ministry of Public Health issued a policy to have ODS featured in provincial hospitals, that the public learned about this practice. Nevertheless, Phaholpolpayuhasaena Hospital has in fact been offering ODS services for over 20 years, since long before the Ministry’s announcement.
Dr. Wibun Phanthabordeekorn, Surgical Specialist at Phaholpolpayuhasaena Hospital in Kanchanaburi and one of the ODS pioneers, said that the hospital initiated the practice to solve the problem of too many patients 20 years ago. Back then, the common practice was to perform surgery with the patient under anaesthesia which required patients to be admitted to hospital one day prior and rest one to two days after the operation before being discharged. This led to overcrowded wards with no room to treat other imperative cases.
Inspired by inguinal hernia surgery that uses a local anaesthetic applied to the targeted part of the body and helps patients recover faster, Dr. Wibun studied and expanded the practice to other types of surgical operations. In 2015, he developed an ODS guideline with anaesthesiologists, leading to standard treatments with no complications or deaths. Later, in 2017, a One Stop Service centre was opened to streamline the treatment process. Every step from first appointment and nursing advice to patient preparation and anaesthetic assessment is conducted at the centre.
The unique feature of ODS is that patients’ relatives are involved in the care process under the supervision of a professional nurse.
“The relatives and patients receive health literacy instruction from the hospital,” explained Dr. Wibun. “Patients are prepared at home by the relatives. At the initial appointment, the nurses teach the relatives about the disease and the operation and give them a schedule and contact details. Then they receive a date for the surgery and preparation guidelines. Four days and one day prior, the hospital calls to assess whether the patient is ready for the operation. The calls not only benefit patients in terms of their readiness but help the hospital to operate smoothly and not miss the chance to maximise the facilities.”
After the surgery, an assessment is conducted prior to discharge. If patients want to rest at the hospital, they are welcome to do so. However, when asked, they usually prefer to recover at home. The relatives also benefit in that they can continue their daily life more easily. After discharge, the nurses call to check the patient for three days. A hotline at 1669 is available round-the-clock in case of emergencies. In this way, the hospitals can reduce cost, staff workload, and the number of in-patients, resulting in better care.
In future, the ODS platform will be expanded to hospitals in every province. Disease coverage is also increasing. In 2020, eight more operations will be included in the platform, bringing the total number of operations available to 32.
Dr. Wibun says he believes that ODS will disrupt the public health sphere as we now know it. “Previously there were only two options: in-patient or out-patients. Hospitals were overcrowded. But with ODS, more hospital beds can be available to those in critical need and with the help of relative involvement medical staff can take better care of each patient.”