Determining Patient Discharge Criteria in an Outpatient Surgery Setting

Abstract

Discharge of an outpatient surgical patient to home implies that the patient is clinically stable and capable, to some degree, of self-care. Nurses currently have no formal evidence-based clinical criteria to assist them in determining outpatient surgical patients' readiness for discharge to home. Nurses often make discharge decisions based on their education, experience, and personal beliefs. The goal of this quality improvement project was to identify specific factors that outpatient surgery nurses consider in assessing readiness of patients for discharge. The results were used to develop orientation and educational programs for outpatient surgery staff members and were incorporated into a patient discharge assessment checklist.

Quality of counselling for knee and shoulder arthroscopy patients during day surgery

“…In day surgery, patients have to take earlier responsibility for their own care, making counselling even more important . Good quality counselling on how to care for themselves at home has been found to facilitate patients' recover after day surgery (Kingdon & Newman, 2006, Knier et al, 2015.…”

The dermatology outpatient discharge decision: understanding a critical but neglected process

“…A major influence on discharge decisions was if patients were asymptomatic or had self‐limiting disease . The stability of patients' vital signs, their orientation and alertness were the main factors determining surgical outpatient discharge readiness . Nonclinical influences such as medical intuition or experience were important but less influential .…”

“…Protocols and clinical guidelines must always be subservient to the clinicians’ judgement of what is best for that particular patient at that time . In the outpatient surgery setting in the U.S.A., nurses acted on their ‘gut feelings’ or ‘medical intuition’ in determining patient readiness for discharge as well as mainly considering patients' clinical symptoms and signs post‐surgery . Although not considered an important influence, it was incorporated in a ‘final discharge assessment’ which was developed for outpatient surgical patients …”

“…One study has highlighted clinicians’ use of medical intuition informing their discharge decisions . Intuition is based on a dual process of a nonconscious, automatic approach and a conscious, analytical approach, ranging from deciding on what first comes to mind to an experience‐based intuition .…”

The development and clinical evaluation of a ‘traffic-light’ design dermatology outpatient discharge information checklist

“…There has been much attention to inpatient discharge planning and on how to reduce outpatient attendances . However, very few studies focus on how to improve outpatient discharge decision making . The differences between outpatient and inpatient discharge are emphasized by comparing the items of our outpatient checklist with an inpatient checklist designed for patient use; there are only three similar items.…”