23 Hour Ward

A 23 hour ward is a surgical care unit which manages the patient’s surgical admission within a 23 hour period. Patients are admitted, prepared for their surgical intervention, monitored and provided with the appropriate pain relief post surgery.

23 hour ward is beneficial when:

  • High volume, low complexity surgical cases
  • Poor access to elective surgery
  • Poor efficiency of operating theatres
  • Longer length of stay for surgical patients

23 hour ward admission criteria guideline

Expected benefits

  • Reduced percentage of cancelled elective surgery
  • Reduced waiting lists
  • Improved efficiency of operating theatres
  • Reduced access block within the emergency department
  • Improved patient experience
  • Reduced length of stay for surgical patients


Many factors determine the structure and organisation of any unit and one size does not fit all hospitals.

Factors include influencing the decision to establish a 23 Hour Ward include:

  • Size of hospital and number of low complexity cases
  • Surgeon and nursing availability
  • Speciality mix within hospital

Key principles

  • Appropriate patient selection using admission criteria
  • Flexible admission times to stagger admission and surgical interventions
  • Specific units with designated beds
  • Discharge within the 23 hour time period
  • Use of criteria led discharge
  • Located in close proximity to operating theatres
  • Established clinical protocols – these protocols streamline patient care processes, support safe practice and quality clinical management and encourage patient focused care


  • Have a proactive, protocol-based system of planned surgical care that will improve patient care and reduce delays and cancellations
  • Increase elective surgery throughput and decrease waiting lists
  • Ensure all patients have a pre-admission review
  • Develop a pre-operative service that has a multidisciplinary team approach
  • Improves the discharge planning process to ensure it identifies additional supports required by the patient on discharge
  • Performance indicators

    • Reduction in surgical DRG length of stay
    • Reduction in the number of long wait patients
    • Increase in the percentage of patients treated with a length of stay less than 24 hours

    Also known as

    • Extended Day Only Unit
    • 23 Hour Care Unit
    • Day of Surgery Unit
    • 23 Hour Surgical Services
Last updated: 27 July 2017