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In the case of emergency and urgent surgery, assessment should take place as early as possible.⁴¹

Investment in senior staff experienced in the practice of day surgery is required to ensure high quality, efficient processes.⁵⁴

A one time investment may be needed to build a dedicated day surgery unit, setting up admission and discharge lounges, preoperative assessment clinics and allied support staff such as physiotherapy and pharmacy.

Outcome measures in day surgery can be:⁵⁵

• clinical: perioperative clinical adverse events, minor postoperative morbidity pain, nausea and vomiting, sore throat, headache, drowsiness, unplanned return to theatre on same day of surgery, unplanned overnight admission, unplanned return or readmission to day surgery unit or hospital.
• organisational: proportion of elective surgery performed as day surgery, cancellation of booked appointments...

Each DSU should have a system in place for the routine audit of important basic parameters such as unexpected admissions following surgery, non-attendance (DNA) rates, patients cancelled on the day of operation, postoperative symptoms e.g. pain and PONV and patient satisfaction.⁵⁵ The Royal College of Anaesthetists has also issued guidance for audits in day surgery.⁵⁶

Current practice in day surgery includes more complex procedures and more elderly patients. Audit of complications related to wound-healing process and impaired mobility based on risk scores can help improve the safe delivery of day surgery service.¹⁴

Audits should rely only on procedure specific data and not on overall percentages. Auditors can compare activity by procedure and unit.

Out of hours, consultants should be immediately available by telephone for advice and be able to attend the hospital within 30 minutes. Suitably skilled and experienced theatre staff should also be available.

Audit and quality improvement should be coordinated and led by designated staff members.

Audit and quality improvement should be integrated into wider areas of anaesthetic and surgical practice.