Department of Health

Establishing a multidisciplinary team

Establish a leadership and governance structure and develop local clinical pathways.

Engaging the perioperative team

Engagement with the perioperative team (see Figure 2) across the entire surgical patient journey is important when developing best care day surgery models. Successful models require executive sponsorship and multidisciplinary team (see allied health support) involvement in developing and implementing pathways.

Implementation should be guided by an agreed project plan that is appropriately resourced. Local steering committees and working groups should be established to support day surgery programs. It is essential to identify all relevant stakeholders who may be impacted by the introduction of a day surgery model. This includes clinical and non-clinical staff and executive leadership.

Figure 2: The perioperative care team (POCT)

Figure 2: The perioperative care team (POCT)
A framework for perioperative care in Australia and New Zealand page 5 ANZCA | Our Perioperative Care Framework
Figure 2: The perioperative care team (POCT)

The person requiring surgery/procedure is central to the perioperative care team:

  • Family/Carers
  • Perioperative medical team
  • Allied Health team
  • Nursing care team
  • Primary care team
  • Surgeon / Procedural team

Download Figure 2: The perioperative care team (POCT)

Establishing a leadership and governance structure

Clinical governance includes all of the integrated systems, processes, leadership and culture that are central to providing safe, effective, accountable and person-centred care, underpinned by continuous improvement.

Strong executive support is crucial for developing, approving, and implementing new day surgery models of care. The role of the sponsor is to ensure project goals are aligned to broader health service strategies and to ensure appropriate project resourcing.

Clinical leaders across craft groups (who ultimately support the patient through their surgical journey) are responsible for the approval of clinical pathway development, escalation procedures and continuous monitoring for safety and quality. Regular evaluation of the model should take place, and work should be underpinned by a robust change and communication strategy accessible to all stakeholders.

The 5 domains of clinical governance are interrelated (see Figure 3) and should be considered by all health services designing and implementing new day surgery models of care. These domains can be tailored to support consumers and staff to work together to achieve high-quality care.

Figure 3: 5 domains of clinical governance

Five domains of clinical governance
Figure 3: 5 domains of clinical governance

The Clinical Governance Framework has 5 components with the central aim of delivering safe, effective person-centred care. The 5 components are:

  • Leadership and culture
  • Consumer partnerships
  • Workforce
  • Risk management
  • Clinical practice.
Download Figure 3: 5 domains of clinical governance

“Clinical governance is essentially an organisational concept aimed at ensuring that every health organisation creates the culture, the systems and the support mechanisms so that good clinical performance will be the norm and so that quality improvement will be part and parcel of routine clinical practice.”
Sir Liam Donaldson speaking at the Conference on the Development of Surgical Competence on Clinical Performance and Priorities in the NHS, November 1999

Developing local clinical pathways

Structured care pathways for day surgery aim to enhance the coordination and continuity of clinical care. These pathways should entail a sequence of decisions and actions that should be documented to ensure clear communication among all parties involved, including the patient and caregiver.

It is important that the clinical pathways are in agreement with the patient and can be adjusted if deemed clinically necessary. The pathway should provide consistent and transparent expectations and education to the patient and caregiver, as well as regular reassessments of their suitability for the pathway or escalation of care if needed.

Ultimately, the clinical pathways or protocols will be determined by the specific procedure or surgery, guided by best practice evidence, and agreed upon by all key stakeholders, while being adaptable to meet local health service needs.

Example pathways for specific procedures exist, such as the NSW Health Joint Replacement Pathways FrameworkExternal Link .

When developing day surgery clinical pathways, there are important considerations at each stage:

Before surgery

  • Risk screening
  • Pre-arrange discharge destination and follow-up plan
  • Individual patient requirements

Day of surgery

  • Fasting protocols
  • Appropriate anaesthesia to support same-day discharge
  • Clinical handover
  • Escalation pathways
  • Criteria for discharge/admission

On discharge

  • Education requirements for patients and caregivers
  • Support required on discharge
  • Escalation pathway post discharge (i.e. how does the patient/caregiver/GP escalate deterioration/concern?)
  • 24-hour follow-up options
  • Handover to community services and primary care providers

Reviewed 24 July 2023