Is Your Day Surgery Patient Ready for Discharge?

To reflect current technology and anesthesia practice, the American Society of Anesthesiologists have standards of care that require that a physician accept responsibility for discharge of patients from the unit. This is the case even when the decision to discharge the patient is made by the bedside nurse in accordance with the hospital-sanctioned discharge criteria or scoring system. If discharge scoring systems are to be used in this way, they must first be approved by the department of anesthesia and the hospital medical staff.  A responsible physician’s name must be noted on the record.

PADSS photoThe American Society of Perianesthesia Nurses (ASPAN) neither requires or endorses any particular scoring system, and leaves the frequency or interval between scores to the individual facility policy. Typically, the minimum assessment would be done on admission to the PACU and on discharge for each level of post anesthesia care. Perianesthesia nurses everywhere, however, recognize the use of  post-op scoring as an integral part of their discharge criteria.  Written discharge criteria should be developed by the department of Anesthesia.  The criteria states a certain acceptable post-op score be achieved prior to discharge.  There are several widely accepted post-anesthetic discharge scoring systems, the most common being the modified Aldrete.

Consciousness Awake and oriented
Arousable with minimum stimuli
Non responsive to tactile stimuli
2
1
0
Activity Able to move extremities
Mild to moderate weakness in extremities
Unable to move extremities
2
1
0
Respiration Able to deep breathe and cough, with no tachypnea
Tachypnea, but able to cough adequately
Dyspnea and unable to cough
2
1
0
Hemodynamics Blood pressure ±15% from pre-procedure level
Blood pressure ±30% from pre-procedure level
Blood pressure ±50% from pre-procedure level
2
1
0
O2 saturation Maintains saturation >92% on room air
Needs to inhale oxygen to maintain saturation ≥90%
Saturation <90% in spite of oxygen therapy
2
1
0

The numerical scores of each category are added up at each assessment and a total patient score of “8” or above must be reached to be able to go home.  There is of course some variability to each facility.  There are also some disadvantages to using the scoring system and many situations rely on good clinical nursing judgement.

In order to be able to determine whether a patient was appropriately discharged, a discharge ” score” system provides a tool- but that’s only a piece of what determines a patient’s overall readiness.  You must know how to interpret the anesthesia and PACU medical records, and know where to focus.

Learn more about how to better evaluate whether discharge criteria was met and where to locate this information in the medical record in my next Blog……part 2

About Jane Shufro

Jane Shufro is the owner of Legal Nurse Collaborative consulting with attorneys, insurance firms, and other legal nurses on both plaintiff and defense medical-related legal cases. She specializes in cases requiring surgical anesthesia, sedation and monitoring, pain management and rapid response or code events.