Abstract
Purpose
The aim of this review was to explore the existing literature on discharge criteria,
tools and strategies used in the postanesthesia care unit (PACU) after ambulatory
surgery and to identify the essential components of an effective and feasible scoring
system based on applicable criteria for the three phases of anesthesia recovery to
assess patient discharge after outpatient anaesthesia.
Design
A review of the literature.
Methods
In this study, a review of sixteen articles was conducted to analyze the affecting
factors, evaluation tools, and the current research status of patients discharge after
outpatient anesthesia.
Findings
The main factors affecting the discharge after diagnostic or therapeutic procedures
under outpatient anesthesia were hospital management, medical treatment and patients
themselves. Physiological systems-based discharge assessment had several advantages
over traditional time-based discharge assessment. The Aldrete scoring scale was often
used for patients in the first stage of anesthesia recovery to leave the PACU, and
the Chung's scoring scale was often used to evaluate patients in the second stage
of recovery until they leave the hospital. These two scales were often used in combination
for outpatient anesthesia. The Fast-tracking assessment tool was used in patients
who directly returned to the ward or discharge of patients after ambulatory surgery.
There is currently no uniform standard or tool for assessing patients discharge after
diagnostic or therapeutic procedures under the outpatient anesthesia.
Conclusions
Optimal care under anesthesia should allow the patient to recover from anesthesia
smoothly and quickly and leave the hospital safely. When the patients can safely leave
the hospital after outpatient anesthesia is still a problem that needs to be solved
in the nursing field. Various existing scoring systems have their historical advancements,
but we need to formulate more in line with the current status of postoperative patients
discharge standards.
Key words
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References
- Using clinical indicators to reduce perianesthesia recovery time following outpatient tonsillectomy.Ann Otol Rhinol Laryngol. 2018; 127: 620-624
- Discharge following endoscopic sedation procedures: an implementation of an evidence-based protocol.Chinese J Practical Nursing. 2019; 35 (【Article in Chinese】): 1869-1872
- Parental satisfaction with autonomous pediatric ambulatory surgery units.Qual Manag Health Care. 2021; 30: 145-152
- A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients.Can J Anaesth. 2015; 62: 1082-1088
- Preoperative evaluation for ambulatory anesthesia: what, when, and how.Anesthesiol Clin. 2019; 37: 195-213
- Anesthesia and sedation outside of the operating room.Korean J Anesthesiol. 2015; 68: 323-331
- Patient selection for adult ambulatory surgery: a narrative review.Anesth Analg. 2021; 133: 1415-1430
Heitz JW. Post-Anesthesia Care:Symptoms, Diagnosis, and Management. Post-Anesthesia Care Unit, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Postanesthesia scoring methods: an integrative review of the literature.J Perianesth Nurs. 2017; 32: 557-572
- Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization.Neural Regen Res. 2018; 13: 280-288
- Fast-tracking ambulatory surgery patients following anesthesia.J Perianesth Nurs. 2015; 30: 124-133
- Risk factors for prolonged time to discharge in total Hip patients performed in an ambulatory surgery center due to complaints of the inability to void.J Arthroplasty. 2021; 36: 3681-3685
- Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis.BMC Med. 2018; 16:2
- Assessment of staffing and service provision in the Post-Anesthesia Care Unit of Hospitals Found in Amhara Regional State, 2020.Drug Healthc Patient Saf. 2021; 13: 125-131
- Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care.Anesthesiology. 2013; 118: 291-307
- Recovery and discharge criteria after ambulatory anesthesia: can we improve them.Curr Opin Anaesthesiol. 2019; 32: 698-702
- Using clinical-based discharge criteria to discharge patients after ophthalmic ambulatory surgery under general anesthesia: an observational study.J Perianesth Nurs. 2020; 35 (e1): 586-591
- Are discharge criteria changing.J Clin Anesth. 1993; 5: 64S-68S
- Recovery pattern and home-readiness after ambulatory surgery.Anesth Analg. 1995; 80: 896-902
- Study on the Influencing Factors of Time of Departure from Hospital in Patients Undergoing Sedated Gastroenteroscopy.Wenzhou Medical University, Zhejiang2020 (【Article in Chinese】)
- A post-anesthetic discharge scoring system for home readiness after ambulatory surgery.J Clin Anesth. 1995; 7: 500-506
- A systematic review of criteria-led patient discharge.J Nurs Care Qual. 2019; 34: 121-126
- Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements 2015-2017.American Society of PeriAnesthesia Nurses, Cherry Hill, NJ2015
- Modifications to the postanesthesia score for use in ambulatory surgery.J Perianesth Nurs. 1998; 13: 148-155
- Criteria for fast-tracking outpatients after ambulatory surgery.J Clin Anesth. 1999; 11: 78-79
- Relevance of oral intake and necessity to void as ambulatory surgical discharge criteria.J Perianesth Nurs. 1997; 12: 413-421
- Use of a modified Postanesthesia Recovery Score in phase II perianesthesia period of ambulatory surgery patients.J Perianesth Nurs. 2001; 16: 82-89
- Post anaesthesia care unit discharge: a clinical scoring system versus traditional time-based criteria.Anaesth Intensive Care. 2004; 32: 33-42
- Modified PADSS (Post Anaesthetic Discharge Scoring System) for monitoring outpatients discharge.Ann Ital Chir. 2013; 84: 661-665
- R.E.A.C.T. A new system for measuring postanesthesia recovery.Nursing. 1984; 14: 101-102
- Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis.BMJ Open. 2015; 5e007200
- Development of a recovery-room discharge checklist (SAMPE checklist) for safe handover and its comparison with Aldrete and White scoring systems.Braz J Anesthesiol. 2021; 72: 200-206
- Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool.J Perianesth Nurs. 2017; 32: 389-399
- A postanesthetic recovery score.Anesth Analg. 1970; 49: 924-934
- Discharge criteria–a new trend.Can J Anaesth. 1995; 42: 1056-1058
- The post-anesthesia recovery score revisited.J Clin Anesth. 1995; 7: 89-91
- New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system.Anesth Analg. 1999; 88: 1069-1072
- From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery.J Perianesth Nurs. 2006; 21: 259-267
- Fast-tracking patients in an academic hospital to increase efficiency and decrease discharge delays: a process improvement plan.J Perianesth Nurs. 2021; 36: 615-621
- The utilization of an opioid-free anesthetic for pediatric circumcision in an ambulatory surgery center.Children (Basel). 2021; 8: 678
- Fast-tracking after ambulatory surgery.J Perianesth Nurs. 2001; 16: 379-387
- Outpatient joint arthroplasty-patient selection: update on the outpatient arthroplasty risk assessment score.J Arthroplasty. 2019; 34: S40-S43
- The history of ASPAN standards.J Perianesth Nurs. 2005; 20: 380-384
- Discharge criteria, impact of the patient and the procedure: what the oral surgeon should now.Oral Maxillofac Surg Clin North Am. 2017; 29: 197-208
- Guidelines for day-case surgery 2019: guidelines from the association of anaesthetists and the british association of day surgery.Anaesthesia. 2019; 74: 778-792
- Postoperative issues: discharge criteria.Anesthesiol Clin. 2014; 32: 487-493
- Criteria for the safe discharge of patients from the recovery room.Nurs Times. 2003; 99: 22-24
Article info
Publication history
Published online: January 18, 2023
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: None to report.
Funding: This work was supported by the Appropriate Technology Cultivation and Promotion Project of Zhejiang Medical and Health Office (grant number 2019325236).
Data Availability Statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Identification
Copyright
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
