To ask anyone in the NHS how day surgery lists are determined?

[ScuderiaSedici]

As above

I’ve worked in several hospitals / departments. It really depends on so many factors that it’s difficult to say. Factors include additional needs, age, transport needs, complexity (or simplicity) of surgery. Sometimes the easy cases go first so the surgeon can overrun on the more complicated cases. Sometimes it’s the other way around (and the simple cases might get cancelled if they run out of time). If people have previously been cancelled, they may be prioritised over similar cases that haven’t been cancelled before etc. You could always phone the secretary and ask, but it’s often not a given until the day anyway.

It’s better to manage complex cases first thing. If they require emergency intervention or input from other professionals, scans etc it’s much better to get it sorted before 1700 when the routine workforce goes home. The after hours staff are much fewer in number. It makes sense from a clinical safety perspective.

It would be foolish to leave early. It will be a wasted slot, and it’s not really fair to anyone to cancel on the day.

I have surgery on my ears regularly and I’m always last/nearly last on the list.

It’s a very simple/basic procedure (one surgeon told me it’s one of the first operations they do when learning) and I have no additional needs so it makes sense to put me last.

I was on a day surgery ward and they had no facility to admit overnight so I guess that would make a difference? Like, giving some people longer to recover to the point of being discharged if it is a more involved surgery?

I had day surgery recently and was first on the list (phoned the day before due to a cancellation) but it turned out that I was the only person on the list! For some reason everyone else booked for that date (start of half term) cancelled. My surgeon was both delighted to have an easy day (finished by 10am) and appalled at the number who cancelled at short notice.

I think the surgeon can switch it around if they want to - I was once slated first on list for an 8 hr operation, and the surgeon came to me and said they'd switched me with the lady who was supposed to be after me as hers was only an hour and it was mad for her to wait all that time. Seemed entirely reasonable to me but whatever person/software had planned it originally obviously thought the opposite!

Clinical need usually. Occasionally surgeon preference. Clinical need meaning generally those least able to wait. Patients who may become unstable while fasting, those who may have acute distress waiting e.g. learning disabilities. Emergencies can come along any time and take the next theatre slot, even if that theatre was being used for day case. Some surgeons prefer their shorter cases first so they don't have people waiting while the handle longer cases, or vice versa prefer to get complex ones finished first. Lots of specialities do complex and day cases on the same day. E.g. an ENT surgeon may have many minor surgeries and also a concern resection scheduled the same day.

The one time I had an operation on the NHS I was at the bottom of the list because I was the youngest. I was there at 7am and I think I was seen at midday.

I had a colonoscopy on the NHS late last year and was able to pick my slot, so I picked the first slot at 8.30 and I was finished by about 10.30.

If there are good reasons, you can always ask and they may consider your position on the list. I asked when I had day surgery a few years ago. I was still breastfeeding my four month old and our house move had fallen on the same day as my surgery. They very kindly put me first on the list, but of course this may not have been possible if there had been other patients to consider clinically.

Please don't do this! Why would you leave? Do you understand the amount of work that goes into booking these lists? The amount of money wasted when people don't turn up/can't be arsed to wait?

Because I’ll have been fasting for near on 24 hours at that point and if it’s got to 2pm and I’ve not been operated on, it’s quite clear u won’t be operated on that day!

Yes im on the day surgery unit but im guess it wont matter.

And it wouldn’t be fair to tell me to turn up at 7:45, just for me to wait till 5pm!

Course not. But it happens. People can be left nil by mouth all day to have their ops cancelled at four. And then for it to happen again and again. It’s awful. It happened to my cousin. But just be aware it may be the case.

Is it an all day list or a separate morning and afternoon day? Is there a particular surgical reason you’ll be fasted that long (that’s not standard ‘anaesthetic fasting’…6 hours for food, 2 hrs for clear fluids). If you were later in the session then it would be normally to carry on drinking at least once the list order has been agreed. Unfortunately someone has to go last, but quite often we don’t know who that’ll be until everyone’s in on the day.

It's really not clear by 2pm! Our afternoon session starts at 2. Theatres run for elective surgery until 6pm.

What is it you're having done?

And I’ve been told to be in the morning session. So if it gets to 2pm, I won’t be operated on. I’m having a minor sinus procedure, there’s no reason I shouldn’t be first.

Morning and afternoon according to my leaflet, im in the morning session.

And I’ll be fasting that long because of when I eat dinner?

Well if they’re separate sessions and you’ve been told to go in for the morning then it’s not going to be a problem. You should check the fasting times though - what you’re suggesting you’ll be doing is not standard.

Ok. Well let's stop the dramatics. You won't have fasted for 24 hours at that point. Unless you decided to skip dinner/supper the night before.

Yes there are reasons you might not be first, as documented on this thread. To be honest you're sounding a little entitled

I saw a documentary recently about the process in the hospital in my area. The doctors stood in a circle first thing in the morning to discuss their patients’ operations. The doctor being televised wanted his patient, a baby, to be first in the queue but ‘lost’ and he discussed afterwards why he was disappointed that other patients went before his.

I pay enough in tax and I’ve waited long enough to not be left fasting until 5 or 6pm the next day.

The OP is asking about day surgery though, they aren't procedures that'd be done in a DSU.

Just to clarify, diabetics only get priority if they are having a GA, which isn’t always the case with day surgery.

@ScuderiaSedici you should be aware that walking out (or cancelling) will, in some instances, result in you being de-prioritised on the surgeon’s list and you may have to wait some time before being offered another slot.