Reasons for delayed patient discharge following day surgery: a literature review

摘要

NHS Trusts face considerable financial challenges. There is a drive to reduce costs by increasing day surgery rates, thereby reducing the length of post-operative stay. Some patients will not meet the discharge criteria to go home following day surgery, for a variety of reasons. They may then require an overnight stay in hospital, creating an unplanned cost. ududAims ududThe aim of this article is to explore the reasons why some adult patients are not suitable for discharge following day surgery. ududMethodsududA pragmatic, mixed-methods approach was used to undertake a critical evaluation of the literature and current practice to determine what is already known about discharge following day surgery. Thematic analysis was used to determine the key themes and issues, enabling recommendations to be made to reduce the incidence of patients who are unable to be discharged following day surgery.ududFindingsududThe main themes or reasons for delayed discharge following day surgery were: post-operative nausea and vomiting, post-operative pain, going late to theatre and social reasons. This was supported by a Trust audit in June to August 2014, which indicated that a patient going late to theatre, had the greatest effect on discharge outcomes. ududConclusionududRecommendations for practice include: the introduction of post-operative nausea and vomiting risk scoring and prophylactic protocols; reorganisation of theatre lists to ensure patients have enough time to recover; and provision of information at pre-assessment, regarding the requirement for a responsible adult escort to take patients home and stay with them for first 24 hours. These changes may help NHS Trusts to improve discharge outcomes for day surgery patients and reduce unplanned costs.