Assessment and selection of patients for day surgery in a public hospital

To describe methods used for adult patient assessment and selection for day case surgery at a major Australian teaching hospital.

A prospective analysis of assessment data and information from the unit's computerised database.

Five thousand day patients consecutively admitted to the Day Surgical Unit, Royal Adelaide Hospital.

The proportion of patients assessed only by trained nursing assessment staff was determined and compared with that for patients requiring additional anaesthetic assessment before surgery. The percentage of patients requiring preoperative investigations was established. Unanticipated hospital admission rates were calculated for surgical, anaesthesia-related and social reasons.

After initial screening by a trained assessment nurse, 46% of patients required additional review by an anaesthetist before the day of surgery. The remaining 54% were assessed by an anaesthetist on the day of surgery. Preoperative investigations were ordered by anaesthetists in 8.5% of all day patients. The assessment methods outlined resulted in a 1.28% rate of unanticipated hospital admissions. This admission rate was mostly caused by complications of surgery (0.94%). Only 0.12% of patients were admitted for anaesthesia-related reasons and 0.14% were admitted for social reasons.

This cost-effective system allows suitable patients and procedures to be identified, with a satisfactory unanticipated hospital admission rate. Satisfactory assessment also results in short preoperative waiting periods, fewer cancellations, reduced postoperative problems and more satisfied patients. The development of an efficient assessment system is aided by the use of a dedicated day surgery area with experienced nursing staff, the use of a comprehensive patient questionnaire and coordination by experienced day surgery anaesthetists.