Regional Elective Day Procedure Centre Pilot- the solution to waiting lists and trainee deficit in the reshaping of services following COVID-19?

Background: Consequences from the COVID-19 pandemic have resulted in the secondary impact of cessation of elective surgical services, amplifying the waiting list problem with devastating patient and surgical training repercussions. With the introduction of the first regional inter-trust daycase elective care centre pilot in Northern Ireland, we aim to assess the impact of this pathway on elective inguinal hernia waiting lists, patient outcomes, and influence on surgical training. Methods: Data was collected prospectively over a 10-week pilot of consecutive elective day case hernia lists at a newly established regional day surgery centre. Key operative time points for each patient were collated via the Theatre Management System (TMS). Retrospective patient feedback was collected from participating patients via 26-question telephone survey at 6 weeks post-operatively. Trainees allocated to the participating units during this pilot received a retrospective electronic survey. Results: Fifty-five patients underwent open unilateral elective inguinal hernia repair, 54% of cases were trainee led. Median trainee operating time of 53 minutes compared with 51 minutes for consultant led procedures, with no significant difference consultant vs non-consultant as primary operator (p>0.05). On completion of the pilot, waiting list numbers were reduced by a third, 75% of trainees feedback reported increased confidence with surgical operative exposure, and high levels of patient satisfaction reported. Conclusion: Inter-trust day surgery at a dedicated green site could successfully contribute to resuming and reforming surgical services, addressing the impact on mounting waiting lists with positive patient impact as well as providing an excellent training opportunity to narrow the observed training deficit.