How a clinical quality registry is redefining short stay surgery

A clinical quality registry, developed by anaesthetist Dr Ken Sleeman, has now surveyed more than half a million surgical patients – and its responses are helping to refine short-stay care throughout Australia.

Boasting an 86 percent response rate, the DayCOR survey is introduced to patients in pre-operative consultations and sent to their phones for completion post-discharge. With just fifteen questions, it can be completed in three to five minutes.

Dr Sleeman, who developed the registry in his role as chairman of the Anaesthesia Continuing Education (ACE) Day Care Anaesthesia Special Interest Group (SIG), says the responses capture both risks and opportunities for short-stay care.

This information is especially crucial for anaesthetics, with short-stay models often requiring an adapted anaesthetic regime to minimise side-effects and ensure same-day discharge.

“The survey doesn’t have any checkboxes, so patients can express themselves freely, as well as giving suggestions on how they think their care could be done better,” Dr Sleeman said.

Previously this information was assessed by checking in with patients over the phone, but this method only had a 40 percent response rate.

“Many couldn’t’ answer the phone because they were either in bed or are back at work. So that was a very difficult method and the survey method beats it by a long shot,” Dr Sleeman added.

So, what exactly does the survey capture and how can it inform short-stay models of the future?

Ahead of the Short Stay Hospital Forum, we spoke with Dr Sleeman to find out.

Pain level and management

Using the standard pain scale, the registry captures people’s pain levels at their worst. A score above three triggers an alert, with a score of four or more requiring immediate intervention.

“Essentially, if the patient feels like frowning, they should be taking medication,” Dr Sleeman said.

Regardless of pain level, patients are asked to verify whether they have supplies of pain medication. Dr Sleeman says most people have paracetamol at home, but many are unsure.

“It’s important for anaesthetists to check and provide some if necessary. Patients should always have access to something if they need it,” he said.

Sleep quality

Questions about sleep quality give further clues about a patient’s pain and comfort level.

“It’s unlikely you will be sleeping if you have pain, nausea or vomiting, and you wouldn’t be sleeping if you were worried in any way, shape or form.

“Again, if a patient indicates poor sleep, it should trigger a response. Most people report average or good sleep, but if it’s poor, the patient should always be contacted,” Dr Sleeman said.

Confusion

Gauging confusion levels in the 24 hours post-discharge is also important, with patients often required to make decisions regarding their health. This is especially true for patients who require major surgery after their initial diagnostic procedure.

“The whole purpose of a daycare case is to make a diagnosis of something – for example, to undertake a colonoscopy if the patient has bleeding. If they go on to require major surgery, and they’re not managed properly postoperatively, confusion can make that a challenging experience for them.

“We’ve got to make sure the patient understands that if it’s a bleeding cancer, for example, you’ve got to remove the source of bleeding if you can. This requires a lot of discussion between the surgeon and the patient – and you don’t want that discussion to happen in a state of confusion.”

Frailty

The inclusion of a frailty scale, developed by Dr Ken Rockwood, has proven a valuable addition to the registry. Frailty is assessed, given its accuracy in predicting surgical outcomes, as well as falls, which are a key threat in the 24-hours post-discharge.

“It gives us clues on how to pre-habilitate the patient. If necessary, we can book the patient in with a physiotherapist, a physician or even an occupational therapist to ensure the patient has sufficient aids at home. If we know there’s a problem early, we can manage it and not have any nasty surprises.

“We might also get the patient seeing a dietician to make sure they’re not on a tea and toast type diet, which is common in older patients.”

Understanding cognitive state

A simple, albeit important, test for cognitive decline is also proving efficacious.

A poor score will signal an alert to the surgeon, who has discretion in how the situation is managed.

Urgent assistance

Patients are asked about whether they needed to contact anyone urgently during their stay and, if so, about their experience of doing so.

“If they answer yes, it will trigger an alert to the receiving hospitals’ team, and be handled by either a senior anaesthetist, or the director or manager of the centre.

“A senior administrator – someone who’s in his office every day – should also be reachable in case of an urgent administrative problem,” Dr Sleeman said.

Post-operative instructions

The survey asks patients to reflect on any post-operative instructions they received. Dr Sleeman says even simple examinations warrant comprehensive instructions.

“We’ve got to make sure patients are eating and medicating as appropriate. A lot of patients are told to stop their medications, but we like them to take all of their medications, excluding blood thinners, right up to the latest possible stage, because that will maintain their status quo.”

Returning to work

Asking patients to report their return-to-work status indicates the extent to which patients require follow up care, beyond what they are already in receipt of.

“If they say they’re not ready, we intervene,” Dr Sleeman added.

Testimonies and suggestions

Asking patients to reflect on positive experiences is crucial for staff morale. Positive testimonies are printed out and displayed on the notice board, while negative experiences are responded to immediately.

Suggestions are also invited in an open-ended fashion. The software is designed to recognise negative suggestions, prompting a follow up with the patient.

“We try to capture everything. It could be that a nurse or admission clerk was overwhelmed with a lot of patients arriving at once, and was short with the patient.

“Or it could be that patients were made to wait too long and the doctor, or their secretary, should have organised an appropriate interval for fasting.”

Further insight

Sharing more on how the registry is impacting short stay surgery, Dr Ken Sleeman will present at the upcoming Short Stay Hospital Forum, hosted by Informa.

This year’s event will be held 3-4 August 2026 at the Crown Promenade Melbourne.

Learn more and register your tickets here.