Planned surgical admissions in a district hospital.

Epsom District Hospital, which has 527 beds, serves a population of about 172 000 in the Mid-Surrey District. At the start of the trial the unit had 22 acute adult beds and a variable number of children's beds in the main hospital. There is a preconvalescent hospital seven miles away where a further four or five beds may be available. These are for patients who have had operations but who are not ready for early discharge. They are also used for patients who live alone or have difficult home conditions and require a period of convalescence and for people who are waiting for geriatric or terminal care accommodation. In the outpatient department the consultant sees most patients who are referred to him specifically and the registrar examines the rest. After any necessary investigations have been carried out the patients who require admission for operation are listed. They are told that they will receive a letter within a week giving them the date when they are to come into hospital. They are asked if there are any periods that would be inconvenient or whether any would be particularly helpful to them. With the admission letter they receive a brochure about the hospital and a form, which they are required to sign and return to the secretary, stating that they agree to the date proposed. One paragraph states that if there is a sudden increase in the number of emergencies resulting in acute pressure on the beds they will be contacted and given an alternative date. All the names, with the type of operation, are entered in a special diary, first in pencil. When an acceptance is received these details are confirmed in ink. Also included are details of day cases and of early admissions for bowel or thyroid preparation and for special investigations or blood transfusions. Patients normally come in on the morning of the day before their operation. Everybody seen in the outpatient department is given an advance booking, except those requiring surgery on varicose veins or wanting a vasectomy. These are kept as a "float," to be sent for if there are any gaps. There are four morning operating lists a week in the main hospital, each lasting about four hours. Two are carried out by the consultant and two by the registrar. The cases treated in the cottage hospitals have not been included in the survey. On a Tuesday morning the consultant and the registrar each have a list in adjacent theatres assisted by a house surgeon and a senior house officer. This permits some flexibility in allowing patients to be switched from one list to another should either be running late. On Thursday the more complicated or interesting cases are operated on. As it is a combined list the whole team is present and instruction can be given to the registrar. The final list is on the following day and acts as a form of "sweeper." It contains a few elective cases but there is operating time available for BRITISH MEDICAL JOURNAL 15 MARCH 1980