PS15 2018: Day surgery

 

List:

·        Premise

·        Requirements

·        Considerations

·        Discharge criteria

 

Premise:

·        Trend towards more day surgery, even if major surgery and major comorbidities

·        Need to ensure patients receive adequate care

·        Decision to go ahead falls to the anaesthetist

 

Requirements:

Patient care

·      Staff qualified and sufficient in number

·      Equipment sufficient (including resuscitation)

·      Infection control attended to

·      Restricted drugs handled properly

Patient flow

·      Pre-admission: screening for suitability and referral to anaes clinic

·      Recovery: both first and second stage areas

·      Discharge planning: system to arrange overnight stay if needed

Logistics

·      Easy access for ambulance

·      Wheelchair accessible

·      Nearby parking

Legal

·      Licensed

·      Outcomes audited

·      Adverse events documented and reported

 

Considerations: is day surgery ok?

 

1.Patient:

ASA

·      1-2 or medically stable ASA 3-4 (but this alone is not enough)

Sleep-disordered breathing

·      BMI <35 (negotiable)

·      Not severe

·      Will require minimal opioid

·      Prefer morning surgery

Children

·      Age limit dependent upon

o    Location

o    Operation

o    Staff experience

·      Watch out if young and premature

 

2.Operation:

Medical

·      A: safe and unaffected

·      B: unhindered, no resp depression

·      C: minimal blood loss and inflammatory response

·      D: not impaired afterward, will need only oral analgesics

Personal care

·      Can eat and drink straight away

·      General care can be done by a helper or district nurse

 

3.Facility:

Setting

·      Urban vs rural

·      Free-standing vs inpatient hospital linked

Services

·      Specialists

·      HDU/ICU

 

Discharge criteria:

 

Pre-requisites:

Medical

·      Normal vital signs and conscious state

·      Pain and nausea ok

·      Wound ok

Personal

·      Eating and drinking

·      Toilet i.e. passing urine required if

o    Patient: BPH

o    Anaesthetic: spinal local or morphine

o    Surgery: urological, inguinal

·      Walking

 

Plan:

Instructions

·      Wounds

·      Medications

·      Diet

·      Mobility

·      Follow up

Logistics

·      Companion to take home and stay the night

·      Access to phone

·      <1 hour from hospital

 

 

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