Introduction
In New South Wales, Australia we embarked on a transformative journey after attending the British Association of Day Surgery (BADS) conference in 2024. Following a comprehensive literature review and sector engagement, data analysis identified high-volume procedures with an average length of stay (ALOS) close to one day as prime candidates for day-only surgery implementation. Five procedures were identified.
Methods
The initiative received approval from our key clinical surgeon and anaesthetic body, the Surgical Care Network and was integrated into the existing monthly surgery dashboard, avoiding the need for a new reporting mechanism. Progress was monitored through the Surgical Care Strategic Committee, which held sites accountable for performance. A SharePoint site was established to disseminate pathways and patient information, facilitating knowledge sharing across the network.
Results
In the first quarter of 2025, the initiative successfully saved 12,000 bed days at a saving of $12.9M across NSW. Implementation varied across sites, driven either by clinical leadership or necessity due to bed shortages. This variation highlighted the adaptability of the guidelines to different operational contexts.
Conclusions
The success of the initial phase has led to the inclusion of three additional procedures in the day-only surgery guidelines. A Power BI dashboard has been developed to visually demonstrate bed days saved down to Dr level, enhancing transparency and accountability. Despite the overall success, the initiative faced unexpected clinical pushback in some areas, revealing the need for ongoing stakeholder engagement and political navigation.
Authors
Sarah-Jane Waller
NSW Ministry of Health, Sydney, Australia
Australian College of Operating Theatre Nurses (ACORN), Sydney, Australia