The South Tyneside FASTRAK service: evaluation of a new model for day surgery

Abstract

Objective: To evaluate a service (FASTRAK) offering general practitioners direct access to day surgery operative waiting lists, based on explicit guidelines regarding patient suitability for surgery and anaesthesia. Design: Notes abstraction for a cohort of patients referred via FASTRAK and a cohort referred via conventional day surgery routes; postal questionnaire survey of patient satisfaction amongst FASTRAK patients and matched controls referred via conventional routes; postal survey of professional satisfaction. Setting: One district general hospital in the north east of England, and all general practices in that district. Subjects: 1278 patients (1100 conventional day case patients; 178 FASTRAK patients) for notes abstraction; 70 patients for patient satisfaction survey 83 general practitioners for professional satisfaction survey. Main outcome measures: interval from referral to operation, and appropriateness of referral; patient experience and satisfaction with hospital and post-discharge care, especially with respect to information provision, for patient survey; overall rating of service, perceived benefits and disadvantages and future intentions for professional satisfaction survey. Results: The interval from referral to operation was significantly shorter for FASTRAK patients by a median of 91 days. Out of a total of 178 FASTRAK referrals, only seven (4%) were inappropriate whilst diagnosis was wrong in three (2%) cases. Patients referred via FASTRAK were much more likely to have received written information prior to admission (83 vs. 37%: χ 2=12.25. P=0.0019). General practitioners (GPs) had positive views of the service; 94% rated it as `fair' to `very good'. GPs, 90%, perceived the main benefit to patients to be a shorter waiting time for operation; 40% felt that the availability of clear information for patients benefited doctors. Increased general practitioner workload was recognised as a disadvantage (61%) and the main barrier to use of the service was lack of eligible patients under the current guidelines (69%). Conclusions: When diagnosis, indication for surgery and fitness for anaesthesia are not in doubt, general practitioners, given appropriate guidance, are able to provide all the necessary pre-operative services that are usually provided in the general surgical outpatient clinic, without prejudicing the quality of care or decreasing patient satisfaction.