A surgical day case is a patient who is admitted for investigations or an operation on a planned non-resident basis, but who nonetheless requires facilities for recovery in a ward or unit set aside for this purpose (Royal College of Surgeons, 1992).

In 1992 the Royal College of Surgeons indicated that day surgery was the best option for 50% of all patients undergoing elective surgical procedures. Patients could receive a faster, more efficient service as day surgery patients, and hospital costs would decrease (Audit Commission, 1990). The National Health Service Management Executive (NHSME) Day Surgery Taskforce (1993) estimated that 60% of all elective surgery should be performed as day cases by 1997–98. By 2002, the NHS Plan predicted that this figure should increase to 75% (Department of Health, 2002). The NHS Institute recently reissued the 10 High Impact Changes for Service Improvement and Delivery, and one of the high impact changes is that day surgery should be the first choice for the majority of elective surgery cases (Department of Health, 2004, pp. 15–21).

Day surgery is a specialist area of care where patients are admitted into a designated day surgery unit for minor and intermediate surgery, and discharged home the same day. Specialist training and education are recognized as important elements for the provision of high-quality patient care in this area, and guidelines have been produced to ensure that patients receive high-quality care (NHS Modernisation Agency, 2002).

The history of performing operations as day cases goes back nearly a century when it was reported in the British Medical Journal that Professor James Nicholl, a paediatric surgeon, and his colleagues had been performing day case operations at a children’s clinic in Glasgow (Nicholl, 1909, cited by Bradshaw and Davenport, 1989).

During the past decade there has been a steady increase in day case treatments and operations. The results of research demonstrate the quality and acceptability of such care alongside cost advantages (Audit Commission, 1991 and National Health Service Modernisation Agency, 2002). Day surgery has become popular, and its practice has accelerated throughout Europe.

Although day surgery is seen as a major vehicle in reducing long waiting lists, it must not be regarded as a panacea for waiting list problems. The shift away from conventional hospital stays towards shorter periods in hospital will herald a change not only in hospital size and layout but also in nursing practice. It is essential, therefore, that nurses take on board these changes and realize the contribution they must make to ensure that they deliver a high standard of patient care within a high-quality service. The commitment of nurses in the day surgery setting to achieve this is paramount, in order to instil in their patients the confidence to accept this shift towards shorter hospital stays and to be adequately prepared for their hospital stay and discharge home.

The time spent by patients in the day surgery unit is short, with the pre- and postoperative periods being condensed into hours rather than days. It could be argued that the patient requires less time to recover from their treatment because of this; however, it must be recognized that, on the whole, although the hospital stay may be shorter, the period of convalescence may not alter greatly from that of an inpatient for the same procedure. The place at which the convalescence period is spent is changed, however, in that it takes place outside of the hospital environment. Whether this period takes 1 day or longer, the impact on the patient may be great. Hospitalization and subsequent recovery at home will impinge on the patient’s social circumstances. It will have implications for work commitments, and the necessary help and arrangements will be needed to achieve a satisfactory and uneventful recovery. It should not be forgotten that fears and anxieties regarding treatment may be just as real in the day surgery patient (Mitchell, 1997).

The role of the preoperative assessment for surgical patients has been discussed in depth in Chapter 1. However, it is worth illustrating at this point how preoperative assessment in day surgery is integral to the whole process. Day surgery has led the way in preoperative assessment, because particularly at the inception of widespread day surgery there were very strict criteria laid down as to the patients who were suitable for day surgery and those who were not. Also, there were strict discharge criteria which initially were very inflexible. However, as day surgery has become the ‘norm’, rather than a new phenomenon, these guidelines have been adjusted to suit the needs of the patient and the service (NHS Modernisation Agency, 2002). It is sensible that when the preoperative assessment was rolled out to incorporate all patients undergoing surgery, preoperative assessment in day surgery was looked at as the model upon which to base it.