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Daycase Rate (%) 78.77
Opportunity £14,787,076
Volume Opportunity 40,713
Rank 1

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Operation Type Daycase Rate (%) Financial Opportunity Volume Opportunity Rank
Tonsillectomy 54.41 £988,304 2,629 1
Laparoscopic cholecystectomy 54.79 £590,748 1,733 1
Diagnostic endoscopic examination of bladder (including any biopsy) 89.85 £542,697 1,721 1
Transluminal operations on iliac and femoral artery 51.15 £528,201 997 1
Endoscopic resection/destruction of lesion of bladder 28.36 £448,268 1,147 1
Therapeutic arthroscopy of shoulder - subacromial decompression, cuff repair 69.29 £369,929 1,255 1
Removal of internal fixation from bone/joint, excluding K-wires 75.54 £361,026 723 1
Examination/manipulation of joint under anaesthetic + injection 94.76 £329,316 813 1
Primary repair of inguinal hernia 72.79 £327,588 946 1
Vitrectomy using pars plana approach 82.74 £323,914 978 1
Termination of Pregnancy 86.83 £322,338 857 1
Extraction of cataract + implant 98.72 £286,994 886 1
Wide local excision of breast (including wire guided) 64.96 £276,341 988 1
Diagnostic endoscopic examination of pharynx/ larynx + biopsy 80.09 £264,397 597 1
Endoscopic insertion of prosthesis into ureter 45.43 £259,709 645 1
Arthroscopy of knee (including meniscectomy, meniscal or other repair) 86.68 £255,873 828 1
Surgical removal of impacted/ buried tooth/teeth 96.69 £234,383 676 1
Excision/biopsy of lymph node for diagnosis (cervical, inguinal, axillary) 78.15 £210,632 394 1
Therapeutic endoscopic operations on uterus (including endometrial ablation) 86.72 £203,365 657 1
Sentinel lymph node biopsy/Axillary sample/Axillary clearance 61.79 £201,857 420 1
Therapeutic laparoscopic procedures including laser, diathermy and destruction eg endometriosis, adhesiolysis, tubal surgery 62.08 £201,249 545 1
Ureteroscopic extraction of calculus of ureter 41.26 £200,700 575 1
Laparoscopic oophorectomy and salpingectomy (including bilateral) 36.65 £198,020 518 1
Bunion operations with or without internal fixation and soft tissue correction 72.23 £196,922 579 1
Laser surgery to vocal cord (including microlaryngoscopy) 64.32 £193,840 430 1
Simple mastectomy (with and without axillary surgery) 10.62 £193,332 374 1
Excision/destruction of lesion of mouth 82.54 £190,473 168 1
Autograft anterior cruciate ligament reconstruction 39.67 £187,857 705 1
Lengthening/shortening of tendon(s) 64.04 £183,675 365 1
Creation of arteriovenous fistula for dialysis 71.13 £183,423 359 1
Open repair of incisional hernia 20.12 £182,228 202 1
Diagnostic laparoscopy 74.74 £170,336 433 1
Endometrial biopsy/ aspiration + hysteroscopy 89.03 £162,665 514 1
Adenoid Surgery 77.60 £157,726 403 1
Septoplasty of nose 74.00 £156,305 576 1
Excision of breast with sentinel lymph node biopsy, axillary sample or axillary clearance 30.68 £155,391 459 1
Excison/biopsy of breast tissue (including wire guided) 84.41 £147,362 480 1
Tympanoplasty 63.02 £142,504 476 1
Operations on foreskin - circumcision, division of adhesions 90.63 £139,221 401 1
Repair of other abdominal hernia 66.24 £138,462 233 1
Repair of umbilical hernia 78.05 £135,601 389 1
Other endoscopic procedures on ureter 38.68 £128,383 261 1
Removal of prosthesis from ureter 82.04 £126,709 317 1
Myringotomy + insertion of tube, suction clearance 93.28 £116,944 333 1
Biopsy/sampling of cervical lymph nodes 78.87 £115,895 257 1
Pilonidal sinus surgery - laying open or suture/ skin graft 75.61 £115,377 304 1
Operations to manage female incontinence 55.43 £115,359 374 1
Cystostomy and insertion of suprapubic tube into bladder 44.60 £114,352 195 1
Carpal tunnel release 97.18 £106,444 260 1
Transanal excision of lesion of anus 50.51 £105,383 217 1
Neurolysis and transposition of peripheral nerve eg ulnar nerve at elbow 83.91 £104,975 210 1
Haemorrhoidectomy 79.26 £99,209 299 1
Excision/destruction of lesion of anus 88.43 £95,616 288 1
Polypectomy of internal nose 66.67 £92,352 325 1
Optical Urethrotomy 44.96 £85,381 287 1
Repair of rectal mucosal prolapse 40.36 £79,834 133 1
Correction of hydrocele 81.78 £69,106 223 1
Dacryocystorhinostomy (including insertion of tube) 71.69 £68,394 246 1
Correction of squint 93.12 £67,464 188 1
Re excision of margins 80.98 £62,018 206 1
Endoscopic extraction of calculus of bladder 21.43 £58,970 143 1
Intranasal antrostomy (including endoscopic) 64.04 £58,590 224 1
Repair of recurrent inguinal hernia 64.97 £58,402 160 1
Resection of prostate by laser 20.38 £58,344 135 1
Operations on turbinates of nose (laser, diathermy, out fracture etc) 79.86 £57,640 204 1
Excision of lesion of peripheral nerve 83.28 £57,619 146 1
FESS Endoscopic uncinectomy, anterior and posterior ethmoidectomy 63.44 £57,533 208 1
Myomectomy (including laparoscopically) 6.50 £56,412 68 1
Excision of lesion of lip 95.89 £55,735 91 1
Varicose vein surgery 87.39 £54,909 210 1
Excision/treatment of anal fissure 86.12 £54,308 193 1
Removal of breast prosthesis 51.88 £53,783 141 1
Surgical trabeculectomy or other penetrating glaucoma procedures 87.06 £51,620 186 1
Modified radical mastoidectomy (including meatoplasty) 38.73 £50,383 180 1
Destruction of lesion of cervix uteri (including loop diathermy and laser) 93.20 £50,104 200 1
Female Sterilisation 87.52 £49,928 190 1
Radiofrequency ablation of varicose veins (VNUS) 92.82 £45,137 196 1
Injection or banding of haemorrhoids 95.47 £44,771 189 1
Endoscopic resection of prostate (TUR) 3.52 £44,306 83 1
Excison/biopsy of lesion of pinna 96.89 £44,101 131 1
Operations on urethral orifice 76.90 £44,014 155 1
Exploration of sheath of tendon (eg trigger finger) 94.20 £39,773 151 1
Endoscopic retrograde pyelography 42.97 £36,851 73 1
Dupuytrens fasciectomy 90.40 £34,858 145 1
Orchidectomy 64.64 £34,392 134 1
Excision lesion of eyelid 97.27 £34,201 113 1
Septorhinoplasty + graft/implant 49.61 £33,062 125 1
Primary repair of femoral hernia 70.81 £32,480 87 1
Enucleation of cyst of jaw 86.60 £28,795 101 1
Ossiculoplasty 59.62 £28,140 107 1
Laparoscopic repair of incisional hernia 19.86 £27,996 52 1
Excision of lesion of parathyroids 13.54 £25,559 81 1
Excision of lesion of penis 82.93 £24,216 64 1
Excision of nail / nailbed 92.85 £23,034 124 1
Operations on nipple 90.55 £23,012 109 1
Excision of ganglion 95.03 £21,341 91 1
Stapedectomy 54.26 £20,923 86 1
Manipulation under anaesthesia of fractured nose (as sole procedure) 94.76 £20,127 80 1
Endovenous laser treatment (EVLT) 95.70 £18,522 55 1
Therapeutic endoscopic operations on pharynx 31.34 £17,528 53 1
Cone biopsy of cervix uteri (including laser) 89.92 £17,421 89 1
Microdochotomy + other operations on duct of breast 88.87 £16,630 72 1
Excision of epididymal lesion 87.22 £15,300 81 1
Excision of submandibular gland 12.26 £15,025 44 1
Laparoscopic gastric banding 8.16 £14,034 45 1
Foam sclerotherapy of varicose veins 97.28 £13,428 35 1
Biopsy/sampling of conjunctival lesion 95.54 £12,933 41 1
Endoscopic incision of outlet of male bladder 11.40 £12,348 36 1
Rhinoplasty 51.46 £12,189 50 1
Circular stapling haemorrhoidectomy 69.75 £11,380 36 1
Endoscopic examination of urethra + biopsy 88.30 £10,988 44 1
Marsupialisation of Bartholin cyst 79.60 £10,471 51 1
Excision of lesion of canthus 97.29 £10,355 32 1
Hemithyroidectomy, lobectomy, partial thyroidectomy 4.81 £10,075 34 1
Diagnostic arthroscopic examination of shoulder joint 74.02 £9,756 33 1
Exposure of buried teeth 96.77 £9,660 33 1
Correction of ptosis of eyelid 97.87 £9,227 28 1
Excision of lesion of eyebrow 96.51 £7,837 28 1
Operations on branchial cyst 21.43 £7,784 24 1
Pinnaplasty (including bilateral) 87.94 £7,616 31 1
Laser photocoagulation of ciliary body 96.10 £7,590 24 1
Blepharoplasty 95.64 £7,582 35 1
Correction of ectropion 97.97 £7,216 29 1
Prostate destruction by other means 9.04 £7,017 16 1
Frenotomy / frenectomy of tongue 95.69 £6,459 40 1
Biopsy of artery (including temporal) 94.32 £5,988 57 1
Colposcopy (+ biopsy) 95.23 £5,847 26 1
Excision pre-auricular abnormality 93.77 £5,417 19 1
Excision of accessory breast tissue 70.00 £5,285 21 1
Correction of entropion 98.48 £5,247 22 1
Vasectomy 97.18 £5,163 43 1
Excision of sublingual gland 21.62 £4,441 18 1
Frenuloplasty of penis 96.86 £4,369 13 1
Nasal septum cauterisation (and bilateral) 82.80 £3,740 16 1
Anorectal stretch 85.23 £3,656 26 1
Lateral sphincterotomy of anus 86.71 £3,538 19 1
Operation(s) on varicocele 90.12 £3,412 33 1
Removal of ventilation device 95.12 £3,314 20 1
Submucous resection of nasal septum 79.17 £2,832 15 1
Biopsy/cauterisation/curettage of lesion of eyelid 98.68 £2,376 33 1
Apicectomy 98.13 £1,875 6 1
Laser iridotomy 95.95 £1,762 28 1
Dilatation of outlet of female bladder 88.00 £1,654 6 1
Interpositional silastic arthroplasty of MCP/ PIP joint 50.00 £1,124 5 1
Excision of lesion of testis 88.10 £906 5 1
Enlargement of lacrimal punctum 99.38 £567 4 1
Varicose vein injection sclerotherapy 97.06 £457 7 1
Adrenalectomy - unilateral (laparoscopic) - - 0 1
Anterior and posterior colporrhaphy 1.73 - 0 1
Anterior colporrhaphy 5.14 - 0 1
Closure of colostomy 0.23 - 0 1
Excision of parotid gland 4.24 - 0 1
Knee replacement (Unicompartmental) 0.96 - 0 1
Laparoscopic nephrectomy 0.25 - 0 1
Laparoscopic pyeloplasty 1.75 - 0 1
Laparoscopic radical prostatectomy 0.66 - 0 1
Laparoscopic repair of hiatus hernia with anti-reflux procedure (eg fundoplication) 11.24 - 0 1
Laparoscopic splenectomy 2.70 - 0 1
Laparoscopic total/subtotal abdominal hysterectomy 1.88 - 0 1
Minimally invasive hip replacement (2 incisions) 0.56 - 0 1
Minimally invasive hip resurfacing 1.93 - 0 1
Pharyngeal pouch-endoscopic procedures 12.50 - 0 1
Posterior colporrhaphy 6.75 - 0 1
Posterior excision of lumbar disc prolapse (including microdiscectomy) 7.44 - 0 1
Repair of enterocele (+ posterior colporrhaphy) 2.08 - 0 1
Vaginal hysterectomy (including laparoscopically assisted) 0.72 - 0 1

Day Surgery is a continually evolving speciality where refinements in surgical and anaesthetic management have led to an ongoing expansion in the range and complexity of procedures now deemed suitable for one day care. The British Association of Day Surgery (BADS) has developed a Directory of Procedures providing aspirational day surgery rates for over 180 operations. Achieving these rates is dependent upon recognising that best practice day surgery is a planned pathway that begins in the GP surgery with knowledge of the procedures that can be feasibly carried out on an ambulatory basis, referral to a care provider with an intention of day surgery management, expectation that the provider will accommodate a quality assured care process with booking, the period of admission, and provision of follow up support in the immediate period after home discharge. Day surgery represents a unique opportunity to achieve both high quality and cost efficient care as ‘best practice’, and as such, is being increasingly rewarded with enhanced tariff payments.

Carrying out elective procedures as day cases where clinical circumstances allow saves money on bed occupancy and nursing care. The day case indicator is the percentage of a subset of high volume and high impact procedures drawn from the Procedure Directory that are actually carried out as day cases

Key steps :

  • Day Surgery should be regarded as an integrated care pathway, and as such, should be managed and optimised by review of every process component from initial referral to post discharge support.
  • Think of day care as the norm for elective surgery and redesign systems accordingly. Rather than asking ‘Is the patient suitable for day surgery?’, the question should be ‘What is the justification for admitting the patient for an overnight stay?’
  • Prioritise use of day surgery units for day surgery requiring full operating theatres, rather than using them for minor surgery and endoscopies that should be moved to other settings.
  • Set an appropriate level of day cases for each of the procedures and then monitor the actual rates at procedure and specialty level. Improvements should then be focused on poorly performing specialties as well as individual procedures. Actions should take the form of implementing procedures and processes that make day cases the norm and inpatient care the exception.
  • Theatre use should also be optimised. Setting aside dedicated theatres for day cases can help reduce cancellations and increase productivity
  • Maximise time for which theatres are used. The Healthcare Commission found that on average trusts plan to use their theatres for 29.8 hours per week, but actually use them for only 16 hours. Cancelled or short-running operating lists and gaps between patients can account for 45 per cent of planned operating hours. One in four day surgery units cancels 9 per cent of operations.
  • Reserve post-operative recovery facilities for day surgery patients. Mixing day surgery patients on a post-operative inpatient ward leads to a high rate of overnight admission as a result of unfocussed “fast track” care, with a subsequent potential for blocking beds. Conversely, the rate of day surgery is limited and cancellations can occur when dedicated day surgery aftercare facilities are used to accommodate elective or emergency inpatients as a result of inpatient bed shortfalls. This leads to cancelled day case procedures and expensive operating theatres standing idle.
  • Pre-assessment of day surgery patients should be carried as soon as possible after ‘intention to operate’ has been confirmed, ideally as a “one stop” process immediately after the out-patient appointment by nursing staff with up to date knowledge of the day surgery pathway.

Further Information

British Association of Day Surgery site

http://www.bads.co.uk

NHS Elect – Service Transformation Tools

http://www.nhselect.nhs.uk/Service-Transformation

Information Shown

This indicator is the percentage of a cohort of operations from the BADS Directory of Procedures performed as a day case. It is expressed as the percentage of all activity so trusts that perform well on the indicator may still have scope for significant potential improvement. The financial opportunity is an estimate of the potential savings that could be achieved if all trusts achieved a rate of day-case surgery in line with the percentile for quarter 1 of that year. The figures are based on trusts achieving the selected quartile performance for each operation so a trust which performs in line with percentile overall but below in one procedure may still show a productivity opportunity. The financial opportunity is calculated by applying the top performing 10th, 25th or 50th percentile provider percentage of day cases for each procedure and by multiplying the length of stay for all patients not treated as a day case by the Long Stay Tariff and Market Forces factor. The financial opportunity is based on the quarter performance. Multiply by 4 to calculate annualised opportunity The volume opportunity is the number of admissions not treated as a day case in excess of the percentile value.

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