Day surgery
teams. Day surgery champions can help this happen, provide education and demonstrate success to colleagues. If there is no enthusiasm for this or management support to facilitate change, then it is a huge barrier to success.
Management, audit and service development Having a day surgery mindset should also extend to management teams within the hospital. If there is no commitment to investment in day surgery staff and equipment, then it can be difficult to have a day surgery pathway that works efficiently. Day surgery should be a priority as it is cost efficient for hospitals, reduces admissions, avoids ‘bed blocking’ and leaves greater number of inpatient beds free for more major surgery patients. Since COVID-19, there has been a large
backlog of elective surgical patients, many of whom are day surgery candidates, so efficient use of day surgery units could help reduce this backlog. Representation at Trust Board level for day surgery can help promote local delivery plans for day surgery and operating frameworks, so that day surgery is viewed as a high priority and supported appropriately. Ideally, day surgery units should have a dedicated Clinical Service Manager, Clinical Director, Lead Nurse and representative Lead Clinicians from the Surgical and Anaesthetic specialties. Failing that, effective champions within the MDT can effect change. Audit is hugely important in facilitating efficient day surgery and lack of input can hinder development and improvement of day surgery services. Audit is the way to gather data your daycase unit performance in order to look at where improvements can be made and then to re-audit once changes have been made to see if you have moved forward. The cycle of audit is essential in maintaining quality in day surgery and quantifying improvements in care or establishing whether moving pathways to day surgery from inpatients
have been successful. Important areas of focus are cancellations on the day of surgery, unplanned overnight admissions, readmissions within 30 days and patients that did not attend (DNA) on the day of surgery. The Royal College of Anaesthetists publishes an Audit Compendium relating to day surgery and the GPAS day surgery chapter recommends audit for the above and also for post-operative morbidity, including pain and PONV, patient satisfaction, day surgery utilisation rates and proportion of elective surgery performed as day surgery.
Conclusion In conclusion every person involved in the day surgery pathway has an important role to play in facilitating successful day surgery. A positive day surgery mindset throughout and the identification of champions often underpins effective change or improvements for day surgery patients. Getting everyone to come on board, from
ward nurses to managers, in the development of day surgery pathways is the only way to ensure success. Whatever facilities are available in different hospitals, they can be adapted and challenges overcome if the day surgery team are well trained, supported and work together. The many barriers to day surgery can then be minimised and the maximum benefit to patients and the service achieved.
CSJ
References 1. Royal College of Anaesthetists. Chapter 6: Guidelines for the Provision of Anaesthesia Services for Day Surgery 2024
2. Bailey C et al. Guidelines for day-case surgery 2019. Anaesthesia 2019;74:778–792.
3. Fehrmann K et al. Day surgery in different guises: a comparison of outcomes. J One Day Surg 2009;19:39–47.
4. Royal College Of Anaesthetists: Raising the Standards: RCoA Quality Improvement Compendium. Chapter 5 Day Surgery Services
5. Centre for Perioperative Care. Preoperative Care for people living with Frailty
https://www.cpoc.org.uk/guidelines- resources-guidelines/perioperative-care- people-living-frailty
6. Pang. G, Kwong, M, Schlachta CM , Alkhamesi NA, Hawel, JD, Elnahas AI. Safety of Same- day Discharge in High Risk Patients undergoing Ambulatory General Surgery. Journal of Surgical Research. Published February 24, 2021 DOI:
https://doi.org/10.1016/j.jss.2021.01.024
7. Smith, I. Cooke, T. Jackson, I. Fitzpatrick R. Rising to the challenges of achieving day surgery targets. Anaesthesia. Volume61, Issue12 December 2006 Pages 1191- 1199
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www.clinicalservicesjournal.com I July 2024 About the authors
Dr. Rachel Tibble is the Honorary Secretary and International Association for Ambulatory Surgery (IAAS) Representative, BADS. She is a Consultant Anaesthetist and has been interested in the development of Day Surgery since starting her consultant post in 2003. She is currently Lead for Day Surgery and Day Surgery Pre-operative Assessment at the Royal Derby Hospital, UHDB. She has been a member of BADS for 20 years and on council since 2022, where she aims to be involved in spreading good practice and excellence in Day Surgery. She has also written a chapter on Day Surgery in the main Textbook of ‘Anaesthesia,’ by Aitkenhead and Smith, based on BADS principles, been a GPAS author for the Day Surgery chapter, and involved in development of competencies for Day Surgery Staff with the AfPP.
Dr. Lindsay Hudman is a Consultant Anaesthetist, at Glasgow Royal Infirmary and the New Stobhill Hospital. Dr. Lindsay Hudman has been a Consultant Anaesthetist in Glasgow, working across Glasgow Royal Infirmary and the New Stobhill Hospital, since 2015. She has been the Anaesthetic Lead for the Local Arthroplasty ERAS Multidisciplinary group since 2018 and was an active contributor to the development of the Scottish ARISE (Arthroplasty Rehabilitation In Scotland Endeavour) Programme Database. She has been an ARISE steering group member since 2021. In 2020, she led the development of the successful day case and short stay arthroplasty programme at The New Stobhill Hospital in the wake of the COVID pandemic, which she continues to monitor and develop. She has recently taken on the role of Anaesthetic Lead for Day Surgery and the New Stobhill Hospital with a view to continuing to broaden the opportunities for day surgery across all specialties in North Glasgow. She has been a member of BADS council since September 2023
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