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Day surgery: operational guide

Waiting, booking and choice

  • Document type:
    Guidance
  • Author:
    Department of Health
  • Published date:
    15 August 2002
  • Primary audience:
    Professionals
  • Product number:
    28554
  • Gateway reference:
    2002
  • Pages:
    40
  • Copyright holder:
    Crown Copyright

This guide is an aide to managers and commissioners to improve efficiency in day surgery units. The NHS Plan sets the patient firmly at the centre of a framework for modernising the NHS. Taking forward the agenda to reduce waiting times, implement booking systems and introduce choice requires fundamental changes in practice and for the NHS to "do things differently".

Day surgery is the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day. "True day surgery" patients are day case patients who require full operating theatre facilities and/or a general anaesthetic, and any day cases not included as outpatient or endoscopy.

Day surgery provides benefits to all involved.

  • Patients receive treatment that is suited to their needs and which allows them to recover in their own home. Cancellation of surgery due to emergency pressures in a dedicated day surgery unit is unlikely. The risk of hospital acquired infection is reduced.
  • Clinicians can provide high quality care for appropriate patients, and release inpatient beds for more major cases.
  • Trusts improve their throughput of patients, facilitate booking, and reduce waiting lists.
  • Primary Care Trusts (PCTs) can commission cost-effective healthcare.

The Audit Commission and British Association of Day Surgery/Newchurch reports identified a number of issues preventing some day surgery units from working to their optimum level. These include:

  • Inappropriate and inefficient use of units, for example treating patients who could be cared for in a treatment room or outpatients.
  • Poor management and organisation, particularly in relation to the flow of patients.
  • Clinicians' preferences for inpatient surgery.
  • Mixing of inpatients and day cases on the same list, leading to cancellations due to theatre overruns.
  • Failure to recognise day surgery as a priority.

Some of these problems can be tackled through improving processes, but others are more difficult as they require a change in culture. Nevertheless, the need to improve patient services, to reduce access times and to improve convenience for patients and hospitals means that these difficulties must be addressed.

This guide is an aide to managers and commissioners to improve efficiency in day surgery units. Taking it forward will also help them improve performance across a range of measures. It is part of an overall strategy, which includes:

  • This operational guide, directed at those involved in planning and managing elective surgical services.
  • Clinical guidance currently being developed with the Royal College of Surgeons. This is looking at criteria for selecting patients for day surgery, training, day care resources and clinical governance, and will complement this operational guide.
  • Work by the NHS Modernisation Agency to help Trusts improve their performance by learning from and building on their own experiences. The Modernisation Agency has appointed a national programme lead to support day surgery expansion, including the development of learning sets. This programme will build on the lessons learned from other improvement programmes, and will work with Trusts to improve patients' experience.
  • A summit in September 2002 for Trusts with low levels of day surgery activity to look at methods of improving their rates, with support from Trusts achieving higher day surgery rates.
  • Appointment of clinical champions to assist Strategic Health Authorities develop day surgery locally.
  • A programme for clinical and managerial champions with an interest and proven track record in day surgery to visit Trusts with low levels of day surgery to offer support and advice.
  • Through the capacity planning exercise that is currently underway, Treasury Capital Modernisation Funding of £31 million in 2002/03 and £37 million in 2003/04 will be available. This funding will help tackle the blockages that cause delays and cancellations and to speed progress with day case booking. In particular, it will help to fund the purchase of medical equipment and small building work, particularly for those organisations which do not have a separate day case facility.

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