146 Day Case Biopsy Pathway: Assessment of Safety and Efficacy – Single-Centre Experience

Abstract

With the introduction of window-of-opportunity trials, the demand for diagnostic brain biopsy surgery is expected to increase. In the context of limited neurosurgical bed availability, a Day Case Biopsy (DCB) pathway was introduced at Queen Elizabeth Hospital Birmingham (QEHB) in 2021 to provide a safe and efficient pathway while avoiding unnecessary delays in the diagnosis of urgent cases. This audit aimed to evaluate the safety, efficiency, and patient satisfaction associated with the introduction the DCB pathway. This is a retrospective analysis of prospectively recruited consecutive patients. Adherence to the DCB standard operating procedure (SOP) was assessed, including 4-hour post-operative imaging timing and findings, duration of hospital stay, and unplanned admissions. Patient satisfaction was evaluated using a structured questionnaire. Between September 2021 and February 2026, 39 patients underwent DCB at QEHB. 33 patients were safely discharged from the neurosurgical service on the same day (29 went home, 2 were transferred to haematology after frozen section confirmed CNS lymphoma, and 2 were repatriated to local hospitals). 6 patients required admission under neurosurgery (2 due to post-operative haematoma, 2 due to post-operative seizures, and 2 due to delayed imaging and discharge letters). Patient satisfaction questionnaires demonstrated high overall satisfaction (85%) with the pathway, with no complaints with the process. Pain management was identified as an area requiring improvement; 46% of patients expressed concern about not having sufficient analgesia provided at home, although this did not impact their care or discharge. The day case biopsy pathway appears to be a safe and efficient model for delivering biopsy procedures within a busy clinical and academic NHS setting. Optimisation of post-operative pain management may further enhance patient experience and pathway effectiveness.