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Day surgery should be a consultant or autonomously practising anaesthetist/surgeon-led service with a dedicated clinical lead or clinical director who has programmed activities allocated to the role within their job plan. The role of the clinical director is to champion the cause of day surgery and to ensure that best practice is followed. This role may involve the development of...

The day surgery unit should have appropriate administrative support involving patient booking for lists and preoperative assessment services, communication with patients about admission times and starving instructions, and reception staff to meet and greet patients on the day of surgery and admit them electronically for their procedure.¹²

Day surgery should be represented at board level.^3,9,13

There should be a senior nurse manager or appropriately trained allied health professional who, together with the clinical director, can provide the day to day management of the unit.

Many larger units, especially those that are freestanding, should consider having a separate business manager to support the clinical director and senior nurse.

The clinical director should chair a management group and should liaise with all those involved in day surgery. This group 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.

Effective preoperative assessment and patient preparation, performed as early as possible in the planned patient pathway, is essential to the safety and success of day surgery.^5,8,12,17

Local preoperative assessment guidelines and protocols should be established. These should be in line with current national recommendations from the British Association of Day Surgery, Getting It Right First Time, the Centre for Perioperative Care, NHS England and the Preoperative Association.^{4,18,19,20,21}

Protocols should be available to maximise the opportunity for patients with significant comorbidities (e.g. diabetes, morbid obesity, sleep apnoea) to be safely managed via a daycase pathway. Preoperative assessment should be inclusive not exclusive.^3,5,12,16