Challenges in ambulatory surgery: discharge criteria.
The weakest link in ambulatory surgery is often the discharge of patients. Protocols and guidelines are important for the safe discharge of patients. The patient who has recovered sufficiently for discharge is considered "home ready", is in the intermediate stage of recovery and is to continue the recovery at home under the supervision of a responsible adult. There are many tests of recovery but none suitable for routine clinical use. The mean hospital transfer rate for a multidisciplinary ambulatory centre is between 0.12% to 1.2%. Gynaecology and urology have the highest hospital transfer rate. Surgical causes of hospital transfer are three to five times greater than anaesthetic causes. Common anaesthetic reasons for hospital transfer were inadequate recovery, nausea and vomiting, hypotension and syncope. Surgical reasons for hospital transfer included bleeding, extensive surgery, perforated viscus and further treatment. The patient should be discharged by a physician after satisfying a checklist of "discharge criteria".
Boey
W K
WK
National University Hospital, Singapore.
D000328:Adult; D000553:Ambulatory Care; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D002985:Clinical Protocols; D006176:Gynecology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007431:Intraoperative Complications / Q000209:etiology; D009325:Nausea / Q000209:etiology; D010343:Patient Admission; D010351:Patient Discharge; D010360:Patient Transfer; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D017410:Practice Guidelines as Topic; D013575:Syncope / Q000209:etiology; D014572:Urology; D014839:Vomiting / Q000209:etiology