Ambulatory Surgery 7 (1999) 155 – 157 Clinical indicators for day surgery B. Collopy a, *, L. Rodgers a , J. Williams a , N. Jenner a , L. Roberts b , J. Warden b a Australian Council on Healthcare Standards, Care Ealuation Program, Leel 9, 41 Aikenhead Centre, 41 Victoria Parade, Fitzroy 3065, Victoria, Australia b Australian Day Surgery Council, Australia Received 18 November 1998; accepted 28 November 1998 Abstract As the number, variety and complexity of day procedures increase it is clearly important to ensure maintenance (and improvement) in the quality of the care given. To do so the Australian Day Surgery Council, assisted by the Australian Council on Healthcare Standards Care Evaluation Program, introduced five generic performance indicators. They were addressed by 240 healthcare organisations in 1997 reflecting the management of over 380 000 patients in day procedure facilities. Aggregate rates for the five indicators in 1997 were: failure to arrive, 1.5%; cancellation of procedure after arrival, 0.9%; unplanned return to operating room, 0.08% and unplanned delayed discharge, 0.56%. The unplanned overnight admission rate was significantly lower in freestanding than in attached facilities and significantly lower rates were noted for private compared with public facilities for all the indicators. Numerous actions were reported by 64% of organisations (as a result of indicator monitoring) including increased patient education, the production of information leaflets, establishment of pre-anaesthetic clinics, alteration of surgical techniques, introduction of drug trials and numerous policy changes. © 1999 Elsevier Science B.V. All rights reserved. Keywords: Clinical indicators; Day procedures; Quality database 1. Introduction In 1995 Ira Rutkow wrote that ‘ambulatory surgery is one of those rare socio-economic political movements in which all participants have benefited as demon- strated by public interest and demand, surgeon satisfac- tion, patient participation and most importantly, payer encouragement and mandate’ [1]. However, there is no mention of quality in this statement and as the number, variety and complexity of day procedures increase it is clearly important to ensure the maintenance (and im- provement) of the quality of care given. This issue has been addressed by the Australian Day Surgery Council (ADSC) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Program (CEP) in the development and implementation of a set of perfor- mance measures or clinical indicators [2]. They now form part of the larger program of the ACHS CEP and the medical colleges which has seen the introduction of 15 sets of clinical indicators into the Evaluation and Quality Improvement Program (EQuIP), the new ac- creditation process of the ACHS [3]. This has enabled the establishment of a ‘national’ database reflecting the quality of medical care. It is unique in its provider (medical college) involvement and the wide range of conditions and procedures addressed [4]. Clinical indicators are defined as measures of the management and/or outcome of care whose purpose is to act as flags of possible problems in patient care. 2. Clinical indicators for day procedures Five generic indicators have been developed reflecting access and efficiency of booking, appropriateness of patient selection, safety of anaesthesia and surgery and discharge planning. They are:  Failure of booked patients to arrive  Cancellation of the procedure after arrival  Unplanned return to the operating room  Unplanned overnight admission  Unplanned delay in discharge greater than 6 h. The indicators were introduced in 1996 for health care organisations undergoing an accreditation survey * Corresponding author. 0966-6532/99/$ - see front matter © 1999 Elsevier Science B.V. All rights reserved. PII:S0966-6532(98)00063-8