Day of surgery

Planning and prioritising day cases

It is important to plan and schedule surgery lists to ensure day ward hours meet the needs of increased day cases.

Considerations include:

• planning for day surgery cases early on the morning theatre list
• scheduling as indicated according to recovery times for different procedures or types of patients (e.g. patients with diabetes, or who are very young or very old)
• monitoring the volume of planned surgery waiting lists and adjusting the capacity of day wards and post-operative support services to meet any increased day case demand.

Allied health support

Multidisciplinary allied health team members are vital throughout the entirety of the perioperative journey, from initial screening to discharge and post-operative care.

Allied health team members may include, but are not limited to:

• physiotherapists
• occupational therapists
• dietitians
• social workers
• speech pathologists
• pharmacists

Key allied health team members, such as a senior physiotherapist, may also be designated to a care coordinator role to facilitate the day pathway.

Roles and responsibilities of allied health team members will be agreed within the context and demands/resources of the individual health service.

Resourcing of evening allied health and nursing support is required to promote safe and successful day surgery.

Examples of allied health roles and responsibilities at different stages of the pathway are as follows.

Before surgery

• Patient assessment and education
• Safety risk assessment
• Early identification and escalation of patient concerns to surgeon
• Scheduling theatre list and arranging follow-up care
• Optimisation and prehabilitation services
• Coordination of discharge support and a follow-up care plan, including a criteria-led discharge pathway

Day of surgery

• Contact person for carer and patient
• Documentation as per local care pathways
• Monitoring and updating the follow-up care plan

On discharge

• Early identification and escalation of patient concerns to surgeon
• Patient and carer education (e.g. mobility, medications, equipment)
• Activity of daily living equipment provision as indicated
• Assessment and management for functional rehabilitation goals
• Contact person for carer and patient
• Care coordination and onward referral as indicated

Criteria-led discharge (CLD)

Introduction of CLD will help support safe discharges. CLD is a formalised discharge approach that requires the patient to meet pre-determined criteria in order to discharge when clinically and socially safe to do so.

CLD is designed to facilitate efficient processes and shared knowledge of discharge requirements among the entire multidisciplinary team. For CLD to be successful, it is essential to have a clear pathway that ward staff can follow without need for medical support.

Implementation of new CLD pathways need to be continuously reviewed to ensure implementation is effective and sustained.

It is important to use quality improvement tools to support implementation, evaluation and continuous improvement.

See also ‘use quality improvement tools to support implementation and sustainability’.

Key steps to CLD development and implementation:

1. Review/develop aim, objectives and scope of implementation
2. Create a governance structure
3. Establish a project team and plan to ensure a sustainable approach
4. Develop CLD documentation
5. Educate and train staff, families and carers
6. Monitor and evaluate indicators and measures