Day case surgery


one of the highest day case rates for joint replacements.


He added that we are also increasingly seeing the use of mobile theatres. While BADS does not see this as a long-term solution to the NHS’s problems, they can help increase capacity and provide support. However, we also need to invest in innovative technology. This not only includes the need for more robots, but also technology to support anaesthetic techniques – including technologies for monitoring muscle paralysis intraoperatively, neuromodular measurement, and monitoring of conscious sedation. He added that we also need investment in digital and remote monitoring technologies – in Yeovil, for example, home monitoring is supporting patients following discharge. Patients return home with an oxygen saturation probe to measure their oxygen levels, a glucose monitor and a blood pressure monitor. They also perform a finger-prick test to


measure haemoglobin levels. This data is then fed back to a digital platform at the hospital, so there is a relay of important patient information in real time. Furthermore, the technology allows two-way communication between staff and patients. There are a variety of App-based platforms now available for post-operative follow-up, and this technology has the potential to support safe patient discharge in the community.


Increasing capacity David Bunting commented that we need to increase capacity, to increase day case surgery, and to look at how we can repurpose the infrastructure that we already have. The GIRFT programme has developed


operational guidance - the GIRFT Practical Guide to Right Procedure, Right Place (RPRP) – to support NHS colleagues seeking to move appropriate procedures out of traditional operating theatres into alternative settings. This includes moving certain anaesthetic procedures from the day surgery environment into procedure rooms, for example. ‘Right Procedure Right Place’ recommendations for procedure room air changes are also now available to support this initiative.


HIT lists David Bunting went on to further discuss the role of High Intensity Theatre lists (HIT lists) in helping to tackle the backlog and increase capacity. This approach uses ‘fallow’ or redundant theatres, at weekends, and includes the use of two theatres, with three teams working across both theatres. Back in 2022, Guy’s and St Thomas’ NHS Hospital Trust hit the headlines as a group of surgeons successfully


58 www.clinicalservicesjournal.com I July 2025


overrun. At Kingston hospital in London, ‘Super Saturdays’ had a similar impact and helped reduce waiting lists, as well as achieving an impressive 97% day case surgery rate. “In the UK, we have been facing somewhat of a healthcare crisis. We are being asked by the government to achieve more for less money. This won’t come as a huge surprise…We are aware of the problem, and we have some of the solutions. Ultimately, day case surgery may help to overcome some of the challenges,” David Bunting concluded. For further information and resources on day CSJ


case surgery, visit: https://bads.co.uk


used a pioneering robotic technique to treat more men with enlarged prostates in one day than anywhere in the world. These record- breaking HIT lists have successfully increased the flow of work that can be achieved.3


Guy’s


and St Thomas’ for example have performed 23 lists, with 410 patients, across nine specialties. They had a 0.5% cancellation rate and only one


References 1. https://gettingitrightfirsttime.co.uk/delivery- pack-supports-trusts-to-think-day-case-first- for-elective-and-non-elective-care/


2. https://bads.co.uk/media/3veavjzm/ afppbads-competencies-with-appendices- final-draft-june-2024-with-title.pdf


3. Furrer, M.A., Ahmad, I., Noel, J. et al. High- intensity theatre (HIT) lists to tackle the elective surgery backlog.Nat Rev Urol, 2023. https://doi.org/10.1038/s41585-023-00775-6


Key actions to support day case surgery


The Day Case First: National Day Surgery Delivery Pack states that the following actions are key to delivering improved day case delivery. 1. Healthcare teams should develop day surgery pathways and ensure a ‘default to day surgery’ approach for all appropriate procedures (these can be found in The BADS Directory of Procedures).


2. Ensure all potential day surgery patients are listed and coded with a day surgery management intent and appropriately code procedures to capture accurate activity in benchmarking data (i.e. Model Health System (MHS) and The BADS Directory of Procedures and National Dataset).


3. Ensure preoperative assessment protocols for patient selection are inclusive rather than exclusive of day surgery.


4. Ensure all patients are given relevant advice on optimisation (exercise, nutrition, smoking cessation, alcohol reduction, psychological and practical preparation) – to improve their health and reduce their risk of complications.


5. Progress towards the development of dedicated day surgery units and teams, and establish a multidisciplinary day surgery management team.


6. Admit all day surgery patients to a dedicated admissions area.


7. Use day case operating trolleys rather than hospital beds.


8. Equip day surgery facilities with high-quality equipment.


9. Establish standardised protocols for anaesthesia, surgical techniques, perioperative analgesia and take-home medication.


10. Ensure that day surgery is a consultant or experienced Specialty and Associate Specialist delivered service, with clear training pathways for the future workforce.


11. Discharge day surgery patients through a dedicated day surgery ward staffed by nurses who are competent in day surgery discharge.


12. Ensure the day surgery unit has no capacity to accept inpatient activity and support this with a commitment from managerial teams to protect this policy even at times of escalation.


13. Have a process in place to support patients following discharge and to collect data on patient outcomes. This may include a telephone call the day after surgery.


14. Record and audit clinical and patient-reported outcomes in day surgery patients. Benchmark performance against the metrics produced by MHS which are based on The BADS Directory of Procedures and National Dataset


Visit: https://gettingitrightfirsttime.co.uk


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