Day case surgery — procedures completed within a single day without overnight admission — is both clinically effective and operationally efficient. The NHS target of 80% day case rate for eligible procedures reflects years of evidence that patients recover comparably well at home, while bed occupancy and infection risk are reduced for the system.
The Problem
Our department's day case rate had drifted below the 80% benchmark. The instinct was to attribute this to patient complexity — sicker patients who couldn't safely be discharged same-day. The audit was designed to test that hypothesis and surface the real drivers.
The Audit
I conducted a structured review of eligible surgical cases over a defined audit period, categorising each case as day case, overnight stay, or extended admission, and for non-day-case outcomes, recording the documented reason for overnight stay.
What We Found
Patient clinical complexity was a minority driver. The majority of overnight stays in eligible cases were attributable to process factors: late start times pushing recovery into evening hours, insufficient pre-operative optimisation flagged only on the day of surgery, and inconsistent application of the day case selection criteria at the point of listing.
- Late theatre start time: cases not completing before the safe discharge window
- Pre-operative gaps: issues identified on the day that should have been addressed at listing
- Inconsistent criteria application: eligible patients listed as inpatient cases unnecessarily
- Post-operative protocol: inconsistent criteria for same-day discharge sign-off
Recommendations
I presented the findings and a structured set of process improvement recommendations to the surgical team. The key interventions targeted the three major bottlenecks: pre-operative optimisation standardisation, a revised theatre scheduling protocol, and a clear day case selection checklist embedded in the listing process.