There were no complications or re-admissions. 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. Ambulatory care, haemorrhoidectomy J.R.Coll. However, in-patient surgery remains the standard practice in many units.
Little information is available on how best to encourage changes in surgical practice.
In the United Kingdom, surgical routine is based around the preferences of individual surgeons who have substantial autonomy. We have observed the effect of the introduction and circulation of explicit guidelines on the introduction of day-case haemorrhoidectomy in a large surgical unit. Day cases were premedicated with dioctyl 3 for 2 days pre-operatively. The guidelines suggested a general anaesthetic open diathermy haemorrhoidectomy with no pack, infiltration with bupivicaine and a diclofenac suppository. 8,9 Nursing staff telephoned patients on days 1 and 3 post-operatively to assess complications and satisfaction.