Discharge Process and Criteria

 

Discharge Process and Criteria Following Day Surgery

There are 3 phases of recovery following anaesthesia:

Early recovery - awakening and recovery of vital reflexes.
Intermediate recovery - recovery to point of 'home readiness'.
Late recovery - recovery to point of 'street fitness'.

Patients are fit for discharge from the day unit when they have completed the intermediate phase of recovery .

Medical criteria to be met prior to discharge from the day unit.

  • Essential invariable criteria
  • Stable vital signs
  • Orientated to preop. stage
  • Minimal nausea and vomiting
  • Controllablel pain
  • No significant bleeding having regard to the procedure
  • Variable criteria
  • Micturition prior to discharge. Essential following epidural or spinal anaesthesia. May be deemed essential following certain surgical procedures.
  • Fixed length of stay in day unit following surgery. Plays no part in the generality of surgical procedures. May be deemed necessary after certain procedures to minimise the risk of reactionary haemorrhage at home eg: tonsillectomy, thyroidectomy.

Disputed criteria

The ability to take and retain oral fluids prior to discharge is increasingly disputed. It may in fact provoke nausea and vomiting.

Non-medical criteria to be met prior to discharge from the day unit.

  • An adult to accompany the patient home and to be with them at home for the first 24-hours following surgery .
  • Acess to a functioning telephone at home.

Patient to be given:

  • Printed post-operative instructions
  • Printed information on whom to contact in case of emergency .
  • Appropriate discharge drugs
  • Follow-up information.
  • A summary of the treatment they have received.

Who should assess fitness for discharge?

  • Surgeon and/ or anaesthetist
  • Senior nurse against a medical approved printed protocol. Surgeon and/ or anaesthetist only involved in cases of doubt or when there is a problem