Day surgery encompasses surgical procedures, including interventional treatments, conducted under anesthesia in designated day surgery units or operating rooms within inpatient departments. Patients are typically admitted and discharged within a 24-hour period in accordance with the treatment plan, excluding outpatient surgeries. In exceptional circumstances where extended hospitalization is medically necessary, the duration of the hospital stay should not exceed 48 h (1). Since its inception in European and American countries during the 1970s, day surgery has emerged as a widely adopted and mainstream surgical management model. This is attributed to its numerous advantages, such as enhancing the operational efficiency of healthcare facilities, reducing patient hospital stays, alleviating the financial burden of hospitalization expenses, conserving healthcare resources, and generating increased social benefits (2). In 2015, the establishment of the China Day Surgery Alliance marked a significant milestone, as the state subsequently introduced a series of policies related to medical insurance, infrastructure support, medical standards, and performance evaluation, thereby significantly advancing the development of day surgery services (3). In 2023, the National Health Commission introduced the “Action Plan for Comprehensively Improving Medical Quality (2023–2025),” which emphasizes the necessity of enhancing the organizational framework for quality management in day surgery to ensure patient safety. The adoption of day surgery represents an emerging trend in the advancement of public hospitals (4). Presently, day surgeries comprise over 60% of elective procedures in European and American nations, with countries such as the United Kingdom and the United States reporting proportions exceeding 85% (5). In contrast, day surgeries in China account for only 12.8% of elective procedures, suggesting that the practice remains in a nascent stage of exploration and development (6). This is compounded by challenges such as regional disparities in development and the absence of standardized information management and uniform service protocols (7, 8). Day surgery nursing service, as the core component of the overall day surgery service, is an integrated care process involving the participation of medical staff throughout preoperative evaluation, intraoperative cooperation, and postoperative follow-up. Existing national surveys mainly provide overview analyses at the macro-level. They lack targeting towards regional specific medical practices, and the research dimension of the core elements of day surgery nursing services is not refined enough. This makes it difficult to support the development of precise local-level quality control standards. In light of these factors, this research conducted a comprehensive survey to examine the processes, content, support systems, and quality management of day surgery nursing services in secondary and higher-level medical institutions across Hubei Province. The aim is to identify the weak links, thus aids in formulating regional standards for nursing services and safety management in day surgery settings within medical institutions, thereby promoting the enhancement of day surgery medical service quality and encouraging the efficient utilization of healthcare resources.

At present, the reach of day surgery remains limited, with only 32.20% of secondary-level and higher medical institutions providing day surgery services. In 87.88% of these hospitals, the annual day surgery volume is less than 3,000 cases. It is evident that there is considerable room for growth in terms of the number of day surgeries performed in medical institutions, and the proportion of day surgeries among elective surgeries should be increased. Concurrently, there remains a degree of polarization in the development of day surgery services. The adoption rate of day surgery in tertiary medical institutions is 72.73%, while that in secondary hospitals is only 12.95%. Within China, there is a pervasive trend of patients relying excessively on high-level hospitals, while neglecting to utilise primary health care services to the fullest extent (9). Promoting a hierarchical diagnosis and treatment system is proposed as a solution to the inadequacy of two-way referral mechanism (10). It is recommended to rationally allocate medical resources at all levels, improve the utilization rate of medical resources in secondary medical institutions, and address the structural imbalance in medical resource supply. In contrast to the centralized management model adopted by international medical institutions, the day surgery management model of medical institutions in Hubei Province is predominantly decentralized. Decentralized management is defined as the management of day surgery services handled by each respective department (11). Its management process aligns with that of elective surgery, and dedicated day surgery appointment and follow-up channels are established within each department. This model offers advantages in bed allocation and specialty-specific management but is not conducive to the standardized management of day surgery across the hospital (12). Building upon the decentralized management model that is predominantly adopted for day surgery in the current domestic context, we recommend its optimization within a homogenization framework. This can be achieved by implementing front-end management via a standardized day surgery procedure directory, enforcing clinical pathway management, simplifying medical record documentation, and establishing robust back-end quality control mechanisms (13).

The number and composition of nursing staff are critical to patient safety (14). This study analyzed the allocation of day surgery nursing staff in Hubei Province and identified two key findings. First, regarding the nurse-to-patient ratio, the median value was 0.90. While this figure aligns with common benchmark standards, it should be interpreted with caution as it is derived from a subset of institutional data. Second, in terms of competency composition, N2-level nurses constituted the highest proportion of day surgery nursing staff. Given that the N2 tier typically represents an intermediate level with relatively limited clinical experience compared to N3/N4 levels, this distribution may indicate a potential area for optimizing personnel structure within the current day surgery staffing model. In light of this structural consideration, we refer to the staffing framework proposed by Yu et al. (15), which recommends a competency-based configuration for specialized settings such as day surgery centers. Their model suggests an ideal composition of approximately 20% N4, 50% N3, and 30% N2 nurses, with no N1 nurses, aiming to enhance the capability of nursing teams in managing complex, high-turnover care without increasing overall staffing numbers. Adapting this structured, hierarchical approach to local contexts could serve as a strategic direction for improving the quality and efficiency of day surgery services.

Research shows that only 66.67% of healthcare facilities have developed clinical nursing pathways for day surgery. Among these, elements like pre-hospital family support assessment, guidance on relaxation techniques during surgery, postoperative psychological and rehabilitation guidance, self-assessment of symptoms and vital signs, and caregiver instruction are less frequently implemented. Studies indicate that patients undergoing day surgery have a low awareness of perioperative safety and generally experience high anxiety levels, which is associated with impaired postoperative recovery. The rate of postoperative complications has risen compared to traditional hospitalization (16). The brief duration of day surgery constrains the time available for effective communication between healthcare providers and patients, resulting in patients and their caregivers possessing inadequate knowledge regarding the disease, its symptoms, and perioperative precautions. This knowledge gap is closely linked to the aforementioned issues (17, 18). The “British Guidelines for Day Surgery” advocate for healthcare professionals to engage in direct communication with patients and caregivers, become acquainted with the surgical environment, and emphasize the assessment and enhancement of psychological and family caregiver capabilities (1). In response to the constraints imposed by limited time, Fang et al. (19) developed a comprehensive nursing checklist tailored for the entire day surgery process, concentrating on the three core aspects of “condition, needs, and outcomes.” By prioritizing patients’ psychological needs and experiences and implementing personalized nursing care, they successfully mitigated patient anxiety during the perioperative period of day surgery, reduced the severity of postoperative incision pain, decreased the incidence of postoperative complications, and enhanced patient satisfaction. Future research should focus on refining the critical components of the pre-hospital, intra-hospital, and post-hospital phases of day surgery. This entails addressing core needs such as patient psychology, family support, and perioperative information to enhance the quality of day surgery nursing and establish a comprehensive pathway for nursing services and health education. Additionally, explore accessible and scalable psychological and rehabilitation intervention models, leverage big data and artificial intelligence to construct personalized patient profiles integrating physiological and psychological characteristics, family caregiver capabilities, and social support levels. Based on these profiles, develop targeted interventions such as intelligent push of perioperative health education videos, AI-enabled postoperative symptom follow-up reminders, and online psychological counseling portals. This approach will realize precise delivery of nursing services, effectively make up for the insufficient communication time in day surgery, and further enhance the quality of personalized care.

Although the day surgery model presents benefits, such as enhancing the healthcare service framework, reducing hospital stays, and lowering hospitalization expenses, the markedly reduced in-hospital duration necessitates that patients undergo the majority of their recovery at home. This situation presents considerable challenges due to the limited professional knowledge and nursing skills of both patients and their caregivers (18, 20). Numerous studies have indicated that professional continuity of care services can deliver ongoing, tailored health education to patients recovering at home, thereby improving patient adherence and self-care capabilities, as well as encouraging the involvement of patients and their families in the care process (21, 22). The International Association for Ambulatory Surgery underscores the necessity for all healthcare institutions to ensure continuity of care for all day surgery patients (23). Our study indicates that 78.79% of medical institutions complete the initial follow-up within 24 h post-discharge for day surgery patients. However, only 65.15% of these institutions conduct more than two follow-ups and maintain comprehensive records for each discharged patient. Furthermore, 34.85% of medical institutions have yet to establish post-hospital rehabilitation plans for day surgery patients. These findings align with those reported by Fang and Yilin (24), suggesting that the continuity of care model for day surgery in Hubei Province is in its nascent stages and necessitates further development to adequately address patient needs. With the advancement of hierarchical medical systems, medical consortia, and related policies, coupled with the ongoing enhancement of community healthcare services, there is potential to develop an integrated hospital-community-family continuity of care model in the future. This model would involve the establishment of multidisciplinary teams, led by advanced practice nursing experts and guided by patient needs, to deliver personalized and comprehensive continuity of care services for day surgery patients. By utilizing a bidirectional referral system, community hospitals and medical consortium institutions can accept patients transferred from higher-level hospitals for preoperative preparation. Conversely, patients who require observation and symptomatic treatment without the need for specialized referral can be transferred to appropriate community health service centers or medical consortium alliance hospitals for ongoing observation and care. This approach not only ensures patient safety but also enhances the quality and efficiency of healthcare delivery. At present, follow-up methods for day surgery is still dominated by telephone follow-up and specialist follow-up. Considering the practical scenarios in medical institutions, a multi-modal follow-up strategy can be implemented. This strategy integrates intelligent platforms, telephone communications, official accounts, and secure social media channels, which adopt strict patient information protection measures for data security. It can establish seamless online consultation channels, ensuring the accessibility of health information while protecting patient privacy. Thereby ensuring the accessibility of health information. Through remote interaction methods such as virtual rehabilitation technology and wearable devices, continuous monitoring, dynamic follow-up, and precise guidance can be provided to patients, ultimately improving post-hospital compliance and overall patient satisfaction.

The development of standardized nursing safety management for day surgery remains inadequate. In this survey, only one-third of the day surgery nursing safety management indicators achieved an implementation rate of over 90%. To improve the safety management of day surgery nursing, it is imperative that medical institutions establish a day surgery center admission management system. This system is crucial for ensuring that patients’ physiological indicators meet the eligibility criteria for day surgery. The implementation of an admission criteria serves as a pivotal measure to reduce surgical risk and ensure patient safety (25, 26). The day surgery admission system should encompass the following: admission criteria for specific disease types and surgical procedures; for surgeons, surgical nurses, and anesthesiologists; and for patients. In particular, when formulating patient admission criteria, a comprehensive evaluation of the patient’s general condition, underlying diseases, and medical risks is required to determine suitability for day surgery. Secondly, it is recommended that medical institutions establish a specialized nursing pathway for day surgery. From 2016 to 2022, the proportion of day surgery in the total number of surgeries increased from 0.59 to 5.19%, and the number of specialized disciplines offering day surgery increased from 8 to 14 (27). The establishment of a specialized disease-specific nursing pathway for day surgery, along with the development of a department list, disease list, nursing list, surgical procedure list, and inspection list, was a way to facilitate integrated and standardized management of day surgery across various specialties and levels. Thirdly, it is recommended that medical institutions establish day surgery outpatient centers. Patients’ pre-admission preparation process involves numerous steps. Establishing a day surgery outpatient center facilitates improvements in the efficiency of and patient experience with outpatient care (28). Fourthly, the day ward and day surgery center are clearly demarcated, with safety signage that is highly visible and unambiguous. Our survey revealed that only 57.58% of institutions met the requirement. Clear physical separation and unambiguous signage are considered essential structural measures to prevent errors and enhance safety awareness among staff, patients, and visitors.

A survey assessing the demand for comprehensive management services among day surgery patients identified the requirement for a management platform as a key service expectation. This finding suggests a positive correlation between the quality of platform services and patient satisfaction (29). This study showed that 51.52% of medical institutions did not establish an electronic information system for day surgery, and 13.64% of medical institutions utilized intelligent platforms for post-discharge follow-up of day surgery patients. The implementation of standardized and information-driven management processes is essential for ensuring the quality of medical and nursing services, thereby facilitating the efficient and high-quality advancement of the day surgery model (30). With the advancement of smart management, information-based management, and mobile healthcare technologies, current research has developed a comprehensive management platform for day surgery patients, emphasizing health education, surgical consultation, and follow-up as its primary functions. This platform facilitates patients’ understanding of surgical procedures and associated knowledge, thereby effectively addressing their needs for information related to surgery, disease, and rehabilitation (31). Several scholars have employed various information technology tools, including mobile devices, interactive software, and artificial intelligence, to deliver preoperative health guidance and monitor postoperative rehabilitation adherence (32, 33). Jun et al. (34) have focused on health education as a pivotal element, devising a health education pathway based on key educational nodes throughout the diagnostic and treatment process for day surgery patients. They have established a health education knowledge base and developed an intelligent health education platform and patient health profiles utilizing artificial intelligence technology. This approach facilitated the delivery of precise and adaptable health education services, thereby enhancing patient satisfaction and optimizing the nursing service model. Future research should concentrate on the comprehensive integration of technologies like virtual reality and artificial intelligence to foster innovative applications and further develop the “Internet + Nursing Services” model in the field of day surgery management. Specifically, develop preoperative virtual reality simulation modules to assist patients in familiarizing themselves with the surgical environment and procedure. Additionally, deploy artificial intelligence-driven intelligent reminder systems for pre-hospital preparation to overcome the temporal and spatial barriers patients encounter during pre-hospital preparation and post-hospital rehabilitation. To alleviate the limitations of traditional day surgery health education models in terms of continuity, personalization, and interactivity, it is advisable to develop a comprehensive nursing service management platform. This platform should integrate three core functional modules: online one-on-one consultation for perioperative queries, real-time dynamic monitoring of postoperative vital signs and symptoms with intelligent early warning for abnormal indicators, and professional psychological support interventions. Meanwhile, establish a graphic interactive follow-up management system within the platform to conduct phased follow-up after discharge and push personalized rehabilitation guidance based on patients’ conditions, thereby enhancing patient satisfaction with medical service experiences and providing substantial support for the high-quality development of medical institutions.

Through a cross-sectional survey, this study provides the first systematic documentation of the current status of resource allocation, structural characteristics, service content and safety management practices in day surgery nursing services within Hubei Province, thereby laying an empirical foundation for optimizing regional day-surgery service models. Although day surgery has been progressively developing in China, management issues persist within medical institutions. Specifically, the proportion of day surgery among elective procedures and the utilization rate of medical resources in secondary healthcare institutions need improvement. Furthermore, the content of nursing services for day surgery requires enhancement, along with the promotion of continuous nursing models. The development of standardized nursing safety management systems for day surgery requires further development, and intelligent management approaches need to be further promoted.

A limitation is the use of convenience sampling, may introduce selection bias by over-representing hospitals with stronger management foundations. In addition, these findings offer preliminary insights into staffing patterns but should be interpreted with caution due to the partial data availability, and they may not be generalizable to all day surgery providers in the surveyed region. Future research should expand to include other regions, aiming to perform a comparative analysis of differences in the scale and implementation standards of day surgery across various medical institutions. Multi-center studies employing stratified or random sampling strategies would be valuable to validate and extend these findings.