Elective Surgery Programme Implementation Support Guide

The clinical team should be developed to provide a multi-skilled workforce who can rotate within
the areas of day surgery. This provides a well trained, flexible, highly efficient and effective
workforce.
Assisting surgeons to develop day care surgical practices
Day case surgery is now pertinent and should be mandatory for most surgical disciplines.
Hospitals should assist surgeons with the move to day surgery and should provide, where
required, an option to change operating list scheduling to promote day surgery, the possibility of
day surgery lists to replace inpatient lists and incentives to encourage clinicians to work in day
surgery units.
Anaesthetic requirements
High quality anaesthesia is pivotal to successful day surgery and it has been the recent
improvements in anaesthetic drugs and techniques that have allowed more operations to be
completed as day surgery cases. Poorly controlled pain and nausea are common reasons for
unplanned admission after day surgery. As stated above, protocols should be developed for
suitable peri- and post-operative analgesia and PONV, and their effectiveness should be
audited.
Careful selection of patients appropriate for day surgery is also vital. Blanket, routine
investigations are inefficient, expensive and unnecessary - only necessary investigations should
be performed. The need for pre-operative investigations should be determined at pre-operative
assessment (see Chapter 3) and the results reviewed prior to surgery. Abnormal results should
be communicated to the surgical team/anaesthetist before surgery so that appropriate action
can be taken in advance of surgery if required.
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Impact on nursing staff and Allied Health Professionals
Nursing staff play an essential role in the day surgery unit. Staff should receive appropriate
induction on appointment to the day surgery unit and continuing professional development
through competency-based education and training. The nursing staff to will need to gain generic
competencies in all areas of day surgery, as well as core specialist competencies to assure
appropriate skill mix.
71 Model of Care for Elective Surgery