Letters

Early discharge after surgery for breast cancer

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7192.1210 (Published 01 May 1999) Cite this as: BMJ 1999;318:1210

Three quarters of patients could not be discharged early, even with support

  1. D W England, Consultant surgeon,
  2. Liz Hopkins, Clinical nurse specialist, breast care
  1. Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham B15 2TH
  2. Division of Surgery, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, New South Wales 2310, Australia
  3. Department of Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF
  4. South Manchester University Hospital, Manchester M20 8LR
  5. CRC Psychological Medicine Group, Christie Hospital, Manchester M20 4BX
  6. South Manchester University Hospital, Manchester M20 8LR

    EDITOR—We too have found the positive effects of early discharge of patients with breast cancer. Of our last 100 operations for breast cancer, 23 patients were suitable for and accepted early discharge with the axillary drain in situ. Interestingly, 41 patients were deemed fit enough for early discharge and to have adequate social support but declined for various reasons, including feeling safer in hospital, needing the rest, and problems associated with the husband's employment. Two patients who had paid into the hospital's “Saturday fund” were anxious to stay in hospital as payments are related to the number of days in hospital.

    The unit in Bundred et al's1 study had a policy of daily phone calls and daily visits by a breast nurse after early discharge. Few breast units are likely to be able to afford to employ highly skilled breast care nurses for this purpose. Our policy is to give full oral and written information relating to management of the drain and a 24 hour contact number; during the week after discharge the patient is brought to the clinic once and phoned at home once. The general practitioner is also informed of the patient's discharge with the drain in situ. With this policy we have not experienced any problems related to the drain and have found patient satisfaction to be high.

    The most important aspect of Bundred et al's study is that 73% of patients were unable to be discharged early, even with a high level of support. The significance of this is brought out in Fallowfield's editorial.2 Clearly, …

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