Day case surgery
hospitals, although some are aspirational. The National Dataset shows variation persists
in day surgery performance across UK hospitals and outlines the potential release of inpatient beds and cost savings that can be achieved if the BADS targets are met. David Bunting explained that the government set a target of 85% for all the procedures in the BADS directory to be achieved by the end of March 2025. He reported that, in 2020 (just after the
COVID-19 pandemic), the day case rate was around 81%. “That has steadily increased over the years, and it is now around 84%, [*figures were accurate at the time of the conference, on 11 March 2025]…Nationally, we are on target and the UK has, historically, been seen as a leading light in day case surgery,” he continued. The UK day case rate is higher than many
other countries. For example, China – which performs 70 million operations per year – has a day case rate of only 14%. “Some of those are actually the 23-hour definition rather than our day case definition,” he explained. “In addition, many of these ‘day cases’ in China, are actually convalescing in a hospital hotel facility rather than at home.” While the rate in the UK has been improving
over time, there are a number of Trusts that are falling below the target of 85%, so further improvement is needed. “The majority of high volume, low complexity
procedures should be performed as day cases. There are two ways of looking at the failures of day case; either there is a failure to book as a day case, and the patient follows the inpatient pathway, or the patient is booked appropriately as a day case, but they have an unplanned overnight admission. There are many reasons for this, but this is something we can look at,” he commented. There are other ways of improving theatre efficiency and productivity, he acknowledged,
including looking at theatre utilisation times, and this may include looking at factors such as late starts and early finish times.
Optimising the pathway Optimisation of the day case pathway is vital. There needs to be an expectation among all healthcare workers, from the start of the pathway in primary care, that most operations will be performed as a day case procedure. Secondly, in the outpatient clinic, patients need to be booked as day cases as the default, unless there is a very good reason. “There are very few reasons why patients cannot be treated as day cases,” he asserted. Surgical technique is the least important
factor in the day case pathway, he commented, although there are some factors that can “standardise surgical and anaesthetic techniques” to help reduce post-operative nausea and pain – thereby maximising the chances of patients going home on the same day. Discharge should be nurse led, where possible, to avoid delays in waiting for surgeons or anaesthetists to discharge the patient. He added that there is an opportunity to introduce more complex procedures into the
day case environment and the UK is currently pioneering in this field. Total hip and knee replacement are increasingly being performed as day case surgeries. Complete oncoplastic breast surgery and adrenalectomy procedures are also being performed as day surgery cases, and we are also seeing robots performing minimally invasive prostatectomies with same day discharge. He highlighted the fact that BADS hosts a series of virtual educational sessions throughout the year, as well as an annual conference, to help drive improvement across healthcare organisations. It also works closely with organisations, such as the International Association for Ambulatory Surgery (IAAS), and national bodies, such as the Getting it Right First Time (GIRFT) programme and the Association for Perioperative Practice (AfPP). This has included the joint development of a useful document on Core Competencies for the Day Surgery Team.2 The document provides recommendations for core competencies for adult day surgery through admission, anaesthetic room, theatres, first-stage recovery and second-stage recovery and discharge.
Investment in resources and infrastructure Surgical hubs are vital in increasing surgical capacity to enable quicker access to safe elective surgical care for patients. David Bunting went on to highlight the recent development of day case surgical hubs – such as the South West Ambulatory Orthopaedic Centre (SWAOC). In addition to running two operating theatres
for day cases, SWAOC carries out short stay elective orthopaedic procedures. The unit is a GIRFT Accredited, award winning, surgical hub, based out of the original Nightingale Exeter Hospital, developed on the site of a repurposed Homebase building. Today, SWAOC is equipped with state-of-the-art equipment, innovative clinical pathways, experienced surgical teams and enhanced onsite medical cover. It has
July 2025 I
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