Continuous quality improvement in a day ward

The increasing usage of short-stay facilities within Australia has focused attention upon the efficiency of surgical day wards. Although the Australian Council on Healthcare Standards (ACHS) is actively promoting the development of clinical indicators for same-day facilities, there is a concern that these measurements relate to efficiency rather than to humanitarian aspects of the quality of service. We have established a programme of continuous quality improvement (CQI) in a surgical day ward with the nursing and clerical staff being empowered as core members of the team. Reviews and audits have identified a number of targets for our activity. Some issues have been resolved very easily (ward clerks telephoning patients to confirm admissions the next day) but the solution to some other problems has required lengthy negotiations between various groups (the construction of clearly written pre-admission guidelines for patients). Activities aimed at improving the service provided to patients attending surgical day wards must extend beyond the mere collection of information about clinical indicators.