Discharge following day surgery

Following a day case procedure under general anaesthesia, which one of the following

is NOT a criterion for approval of discharge from the day surgery unit?

a) Able to ambulate unassisted

b) No pain or mild pain controllable with oral analgesia

c) Agreed carer for 24 hours

d) No bleeding or minimal bleeding or wound drainage

e) Stable vital signs for one hour

Answer: a

Explanation

The British Association of Day Surgery publishes guidelines for discharge procedures

from day surgery units on which, it is suggested, local guidelines should be based. The

guidelines have the objective of ensuring safe, best practice but are pragmatic in their

application of common sense. If a patient is unable to walk pre-operatively, insisting on

postoperative ambulation may lead to prolonged admission. Also, if the patient has

had lower limb orthopaedic surgery, many of which procedures may be performed as

day cases, they will need assistance to ambulate but are perfectly fit for discharge. The

main factors to consider when assessing suitability for discharge are vital signs,

cognitive orientation, pain control (and analgesia to take home), wound status, nausea

and vomiting, activity level (self-care/ambulation), micturition, oral intake, escort

home and carer for 24 hours, written and verbal instructions and a ‘safety-net’

(i.e. ‘what to do if . . . ’). These have been structured into scoring systems where a

patient must achieve a threshold score before being labelled suitable for discharge.

However, the British Association of Day Surgery does not recommend these scoring

systems over a simple tick list.

Reference

Cahill H, Jackson I, McWhinnie D. Guidelines about the discharge process and the

assessment of fitness for discharge. British Association of Day Surgery Handbook

Series. Online at: www.daysurgeryuk.org/bads/ (Accessed 30 November 2009)