A Case for Day Hospitals

August 2020

A case for day hospitals and a reminder of ancient Chinese healthcare principles…

Many with a career in healthcare have at some point heard the phrase “prevention is better than cure”. This originating from the likes of Dr Li Shizhen from the Imperial Medical Academy during the Ming Dynasty, who advocated the role of the doctor in the overall health of the patient as more important than a person visiting a doctor when things went wrong. His view was that doctors should play a more integral role in the life of the people they looked after, and he believed –

  • “To cure disease is like waiting until one is thirsty before digging a well”.
  • “The doctor should be paid as long as the patient was healthy.”

In many ways this is what we are lacking today, even before we were faced with the COVID-19 pandemic. We develop new technologies and systems to help people in more diverse ways. The focus is often on the latest detection techniques or the most advanced treatment, it is a reactive system out of touch with a core question – what is the purpose and/or mission of the doctor, a hospital and/or the field of medicine?

At this point you might be asking “what does this have to do with day hospitals and ancient Chinese healthcare principles?”

The main objective and focus of day hospitals are to provide diagnostic and surgical procedures on a same day basis. Day hospitals offer alternative settings for appropriate elective day surgery for patients suited to day hospital environments. A new generation of South African day hospitals emerged over recent years. In line with international trends, day hospitals in South Africa have been increasing in numbers and services offered.

International trends in day hospitals/day surgery centres across America, Europe and Australia have shown –

  1. An increase in the number of surgeons working in day hospitals.
  2. Momentum in disciplines such as orthopaedics, gynaecology and urology moving more procedures to day hospital environments.
  3. A wider variety of procedures per discipline, performed in day hospitals.
  4. Medical funders moving away from traditional hospital networks, revoking co-payments for patients choosing non-DSP hospitals and co-payments linked to certain procedures.

In many respects, South African day hospitals are experiencing the same trends, but research also highlights how our day hospital industry is lagging. When looking at these trends we are also sensitive to the vast socio-economic differences between South Africa and the rest of the world. However, opportunities still exist to unlock the potential and value of day hospitals moving forward.

Since the onset of the pandemic we have seen the amazing response and preparation by all healthcare contributors, across private and public sectors, taking hands and working together like never before, collectively facing and fighting this storm as best we can to the benefit of all South Africans.

Day hospitals, borrowing from “Chinese principles” and adopting it to our current reality during the pandemic, is extending a helping hand to our acute hospital colleagues –

  • Acute hospitals are best able to treat COVID-19 patients and the burden of these patient loads in some areas are severe.
  • Day hospitals only surgically orientated, with every COVID-19 prevention protocol in place, can help to unburden the greater healthcare system by continuing with appropriate surgical care, in smaller settings, providing peace of mind to both surgeons and patients.
  • Likened to the Chinese principle in caring for patients, day hospitals help by continuing with appropriate and necessary day surgical care for healthy patients, apart from the response demanded by the COVID-19 pandemic. It appears that the advantages of day procedures in day hospitals are significant in reducing

the risk of possible COVID-19 exposure compared to acute hospitals battling the pandemic on the front lines.

Rather than deferral or exposure, we have the option to treat patients in smaller safe zone day hospitals and get them home as soon as possible.

Stay safe, remain strong!

Prepared by the Day Hospital Association of South Africa (DHA) August 2020

For editorial review and questions contact – Leonie Bredell – Relationship Manager management@dhasa.co.za