Day Surgery in Australia: Qualitative Research Report
Markovic, Milica, Bandyopadhyay, Mridula, Manderson, Lenore, Allotey, Pascale, Murray, Sally, Vu, Trang, Journal of Sociology
Day surgery patients are admitted and discharged on the same day for a planned non-resident investigation or operation (CDHAC, 1999; Otte, 1996). This type of surgery has become increasingly prevalent worldwide (Sanares-Ousley et al., 1999), and by the mid-1990s, between 50 percent and 60 percent of all elective procedures in Canada, the UK and the US were day surgeries (CDHAC, 1999; Millar, 1997; Mitchell, 2000). In Australia, day surgery as a percentage of all surgical procedures has increased from 7 percent in the 1980s to about 41 percent in 1997-8 (AHOL, 2001; CDHAC, 1999). In the late 1990s, 39 percent and 44 percent of all surgeries were performed as day surgery in public and private hospitals respectively (CDHAC, 1999: 4-5). By 2001, 55 percent of all surgeries were performed as day procedures (AHOL, 2001). The latter is close to the Australian Federal Government target of 60 percent (CDHAC, 1999: 8). In Victoria, the study site, 38.71 percent of surgeries were performed as day surgery in 1997/8 (CDHAC, 1999: 35). There are multiple reasons for the increase in day surgery, including improved anaesthetics (Moran and Kent, 1995; Stephenson, 1990), technological advances (Mitchell, 2000; Moran and Kent, 1995; Otte, 1996), the need to reduce patients' waiting lists (Edwards, 1996; Friend, 1999; Sierra et al., 1995), government funding policies (Callanan, 2002; DHS, 2001), and cost-effectiveness (AHOL, 2001; Roberts, 1996).
While increasing numbers of patients are now undergoing surgery as outpatients, we have a limited understanding of their expectations and experiences, particularly in Australia. Most research on day surgery has been quantitative, including regular data collection at discharge which surveys patient satisfaction with hospitalization. Although day surgery is neither 'care-free' for the patients or their families following discharge, nor pain-free (Beauregard et al., 1998; Jenkins et al., 2001; Joshi et al., 2000), quantitative research suggests it is generally well accepted by the patients (O'Connor et al., 1991). They favour it as less disruptive and less time-consuming. The employed, who increasingly require after-hours and weekend surgery, and mothers of small children and other carers find it very convenient (Kerin, 2001; Read, 1990; Stephenson, 1990). Quantitative research also proposed patient information provision (de Jesus et al., 1996; Mitchell, 1997) and anxiety management guidelines (Wicklin and Forster, 1994) to meet the health care needs of day surgery patients.
Qualitative research has revealed that patients' experience of day surgery may be improved through adequate information provision, effective communication, educational support and continuity of care. These measures ensure that anxiety and fear prior to surgery are reduced, and the preparation for self-care post-surgery and patients' overall satisfaction with day surgery are improved (Donoghue et al., 1995, 1997; Otte, 1996; Stevens et al., 2001; Vogelsang, 1990; Wiens, 1998). Our study aimed at addressing the paucity of research on day surgery in Australia (Donoghue et al., 1995, 1997), particularly in terms of patients' experience of hospitalization.
Aims and objectives
Our interest in a qualitative component to out study was determined by several factors. First, qualitative research explores the given social phenomena in context, and can give an answer to the question of why that phenomenon differs under different circumstances (see Pope and Mays, 2000). We therefore aimed at analysing how day surgery patients' hospitalization experience is different from the experience of residential surgery patients, notwithstanding that there will be some commonalities. Second, the qualitative approach provided us with information of patients' own perspectives, allowing us to explore the meanings, ideas, concepts and interpretations of the interactions and processes experienced by the study participants. Third, the complexities of day surgery-related anxiety are revealed by this approach (see Mitchell, 1997; Wiens, 1998). …