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The Royal College of Anaesthetists has published guidance for audits and quality improvement projects in day surgery.⁶ Each day surgery unit should have a system in place for the routine audit of important basic clinical and organisational parameters such as:

• clinical: unplanned inpatient/overnight admissions following surgery, postoperative symptoms (e.g. pain, nausea and vomiting) 
• organisational: non-attendance rates, patients cancelled...

Outcome measures in day surgery that should also be monitored are:^9,21

• clinical: perioperative clinical adverse events, postoperative morbidity (sore throat, headache, drowsiness, venous thromboembolisms, unplanned return to theatre on same day of surgery, unplanned return or readmission to day surgery unit or hospital)
• comparator: outcomes for more complex operations should be compared to ensure that day surgery...

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 to improve the safe delivery of a day surgery service.

Audits should rely only on procedure specific data and not on overall percentages. Auditors can compare activity by procedure and unit.¹⁴

Audit and quality improvement should be coordinated and led by designated staff members. Audit and quality improvement should feed into the hospital’s governance process.¹⁴

Audit and quality improvement should be integrated into wider areas of anaesthetic and surgical practice.²¹

Audit in clinical practice and patient care in day surgery should involve all staff. A system should exist for the regular feedback of audit information to staff, to reinforce good practice and help to effect change and, hence, drive quality improvement. This feedback may take the form of regular meetings or updates, or a local newsletter.²¹

For commissioning purposes, suggested indicators of quality of a day surgery unit include:^{9 ,21}

• day surgery existing as a separate and ‘ring-fenced’ administrative care pathway
• a senior manager directly responsible for day surgery
• preoperative assessment undertaken by staff familiar with the day surgery pathway
• provision of timely written information
• appropriate staffing levels
• nurse-led discharge
• provision for appropriate postoperative...

To act as the duty anaesthetist without direct supervision from a consultant or autonomously practising anaesthetist, the duty anaesthetist should meet the basic training specifications and have attained the RCoA’s Initial Assessment of Competence in Obstetric Anaesthesia.^20,21

There should be a duty anaesthetist immediately available for the obstetric unit 24/7. As their primary responsibility is to provide care to those in labour or who require medical or surgical interventions, ante or peripartum, the role should not include undertaking elective work during the duty period.²²