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Training should be multidisciplinary, with the use of simulation encouraged.⁴¹

Appropriate and comprehensive training in this subspecialty should be given according to current standards as defined by the RCoA.¹⁹

Training needs to emphasise the following aspects:

• patient selection and optimisation for day surgery
• provision of effective postoperative pain relief⁴²
• strategies for the prevention of postoperative nausea and vomiting (PONV)
• the necessity of a multidisciplinary team approach in day surgery care
• the requirement for ‘street fitness’ on discharge
• the postoperative management of patients in the community.

Each DSU should have a clinical director or specialty lead. This will often, but not always, be an anaesthetist with some management experience. The role of the clinical director is to champion the cause of day surgery and ensure that best practice is followed. This role may involve the development of local policies, guidelines and clinical governance and should be...

Day surgery should ideally be represented at board level.^8,55

There should be a senior nurse manager who, with the clinical director, can provide the day to day management of the unit.

Many larger units, especially those that are freestanding, may find it helpful to have a separate business manager to support the clinical director and senior nurse.

Preoperative educational resources should be made available to general practitioners and primary care staff who are instrumental in ‘first contact’ patient consultations prior to secondary care referral. This facilitates robust cross-boundary working relationships and agreed ‘fitness for referral’ protocols, whilst minimising delays in the patient journey.

The clinical director should chair a management group and liaise with all those involved in day care. This will include representatives from surgery, anaesthesia, nursing, pharmacy, management, finance, community care both nursing and medical, audit, professions allied to medicine and representatives of patient groups.

Each unit should have a multidisciplinary operational group that oversees the day to day running of the unit, agrees policies and timetables, reviews operational problems and organises audit strategies.⁵⁵