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How to alter surgical practice? The use of guidelines to encourage day-case haemorrhoidectomy

Lookup NU author(s): Professor Rakesh Heer, Dr Stefan Plusa


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Background: Day case haemorrhoidectomy has been shown to be safe and acceptable to patients. The best way to introduce such evidence into clinical practice remains unclear, The aim is to assess the effectiveness of guidelines on the introduction of day-case haemorrhoidectomy in a general surgical unit. Methods: Prospective audit of day-case haemorrhoidectomy and retrospective review of in-patient procedures. The effectiveness of guidelines in encouraging day-case haemorrhoidectomy is assessed by analysis of avoidable admissions. Results: Tn the year prior to introduction of the guidelines 75 patients had elective haemorrhoidectomy, none as day-cases, In the year following the introduction of the guidelines 80 patients had elective haemorrhoidectomy, 35 (44%) as day cases. There were no complications or re-admissions. Of the 45 in-patients 31 (69%) were eligible for day surgery. Conclusions: The establishment of clear guidelines and their dissemination results in significant changes in practice. However, audit has demonstrated that alternative strategies are needed to encourage changes in clinical practice.

Publication metadata

Author(s): Heer R, Dobson D, Plusa SM

Publication type: Article

Publication status: Published

Journal: Journal of The Royal College of Surgeons of Edinburgh

Year: 2000

Volume: 45

Issue: 6

Pages: 369-370

ISSN (print): 0035-8835

ISSN (electronic):

Publisher: Elsevier Ltd