101Smart Ltd.

Exploring failed day-cases and missed opportunities

Daniel O'Neill, Sean Roberts, Karen Stacey
Imperial College Healthcare NHS Trust, London, United Kingdom


Introduction: Improving day-case surgery performance is key to tackling waiting lists, allowing surgery to be performed efficiently despite increasing inpatient bed pressures.

Methods: We performed a service evaluation to identify failed day-cases (patients booked as day-case who were admitted overnight) and missed opportunities (inpatients with a zero length-of-stay) by speciality, explored reasons for this, and identified areas for improvement. The British Association of Day Surgery (BADS) Directory of Procedures was used to define surgeries that should be performed as day-cases in our quarter 3, 2022 data. Notes were reviewed for failed day-cases and missed opportunities, assessing documented reasons, and inpatient interventions that occurred.

Results: There were 2324 BADS day-case procedures with74 failed day-cases and 75 missed opportunities identified.
By speciality, failed discharges as proportion of potential day-cases were: Breast (14.2%), ENT (6.3%), General Surgery (26.3%), Head & Neck (3.8%). Orthopaedics (7.8%) and Urology (14.3%).
Reasons for failed day cases were pre-operative/booking errors (26%), perioperative complications (35%) and discharge issues (23%). 16% lacked any explanatory documentation. 53% of failed day cases had no inpatient interventions. 96% of missed opportunities had no documented reasoning.

Discussion: This work forms part of a larger project to establish changes that could be made to improve day surgery provision. Booking errors resulted in significant failed day cases and missed opportunities. Overnight stays did not equate to further interventions. Documentation surrounding deviation from day-case pathways was poor.
Clinician education and a change in booking forms are potential future intervention targets.