Discharge process

  • Frances Chung
  • Jeremy Lermitte


Ambulatory surgery is continually evolving, with more complex procedures being performed on patients with increasing comorbidities. Recently, more emphasis has been placed on patient recovery and discharge to ensure patient safety and an efficient running of the service.


Regional Anesthesia Ambulatory Surgery Postanesthesia Care Unit Postoperative Urinary Retention Postdural Puncture Headache 


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  1. 1.
    Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg. 1999;88:508–517.CrossRefPubMedGoogle Scholar
  2. 2.
    Aldrete JA, Kroulik DA. Postanesthetic recovery score. Anesth Analg. 1970;49: 924–934.PubMedGoogle Scholar
  3. 3.
    Aldrete JA. The post anesthesia recovery score revisited [letter]. J Clin Anesth. 1995;7:89–91.CrossRefPubMedGoogle Scholar
  4. 4.
    White PF, Song D. New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete’s scoring system. Anesth Analg. 1999;88: 1069–1072.CrossRefPubMedGoogle Scholar
  5. 5.
    Dexter F, Tinker J. Analysis of strategies to decrease postanesthesia care unit costs. Anesthesiology. 1995;82:94–101.CrossRefPubMedGoogle Scholar
  6. 6.
    Apfelbaum JL, Walawander CA, Grasela TH, et al. Eliminating intensive postoperative care in same-day surgery patients using short-acting anesthetics. Anesthesiology. 2002;97:66–74.CrossRefPubMedGoogle Scholar
  7. 7.
    Williams BA, Kentor ML, Williams JP, et al. Process analysis in outpatient knee surgery: Effects of regional and general anesthesia on anesthesia-controlled time. Anesthesiology. 2000;93:529–538.CrossRefPubMedGoogle Scholar
  8. 8.
    Williams BA, Kentor ML, Williams JP, et al. PACU bypass after outpatient knee surgery is associated with fewer unplanned hospital admissions but more phase II nursing interventions. Anesthesiology. 2002;97:981–988.CrossRefPubMedGoogle Scholar
  9. 9.
    Song D, Chung F, Ronayne M, et al. Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery. Br J Anaesth. 2004;93: 968–974.CrossRefGoogle Scholar
  10. 10.
    Millar J. Fast-tracking in day surgery. Is your journey to the recovery room really necessary? Br J Anaesth. 2004;93:756–758.CrossRefPubMedGoogle Scholar
  11. 11.
    Kortilla KT. Post-anaesthesia psychomotor and cognitive function. Eur J Anaesthesiol Suppl. 1995;12:43–46.Google Scholar
  12. 12.
    Chung F, Chan V, Ong D. A post-anesthetic discharge scoring system for homereadiness after ambulatory surgery. J Clin Anesth. 1995;7:500–506.CrossRefPubMedGoogle Scholar
  13. 13.
    Chung F. Discharge criteria-a new trend. Can J Anaesth. 1995;42:1056–1058.CrossRefPubMedGoogle Scholar
  14. 14.
    Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anesth. 2006;53:858–872.CrossRefPubMedGoogle Scholar
  15. 15.
    Lichtor JL, Alessi R, Lane BS. Sleep tendency as a measure of recovery after drugs used for ambulatory surgery. Anesthesiology. 2002;96:878–883.CrossRefPubMedGoogle Scholar
  16. 16.
    Schreiner MS, Nicholson SC, Martin T, et al. Should children drink before discharge from day surgery? Anesthesiology. 1992;76:528–533.PubMedCrossRefGoogle Scholar
  17. 17.
    Kearney R, Mack C, Entwistle L. Withholding oral fluids from children undergoing day surgery reduces vomiting. Paediatr Anaesth. 1998;8:331–336.CrossRefPubMedGoogle Scholar
  18. 18.
    Jin FL, Norris A, Chung F. Should adult patients drink fluids before discharge from ambulatory surgery? Can J Anaesth. 1998;87:306–311.Google Scholar
  19. 19.
    Practice Guidelines for Postanesthetic Care. A report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2002;96: 742–752.CrossRefGoogle Scholar
  20. 20.
    Lau H, Lam B. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization. ANZ J Surg. 2004;74:658–661.CrossRefPubMedGoogle Scholar
  21. 21.
    Pavlin DJ, Rapp SE, Polissar NL, et al. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87:816–826.CrossRefPubMedGoogle Scholar
  22. 22.
    Pavlin DJ, Pavlin EG, Gunn HC, et al. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg. 1999;89:90–97.CrossRefPubMedGoogle Scholar
  23. 23.
    Rosseland LA, Stubhaug A, Breivik H. Detecting postoperative urinary retention with an ultrasound scanner. Acta Anaesthesiol Scand. 2002;46:279–282.CrossRefPubMedGoogle Scholar
  24. 24.
    Mulroy MF, Salinas FV, Larkin KL, et al. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology. 2002;97:315–319.CrossRefPubMedGoogle Scholar
  25. 25.
    ASA Guidelines for Ambulatory Anesthesia and Surgery, last affirmed Oct. 25, 2003. Available at: http://www.asahq.org/publicationsAndServices/standards/04.pdf. Accessed July 9, 2007.Google Scholar
  26. 26.
    Apfelbaum JL, Lichtor JL, Lane BS, et al. Awakening, clinical recovery and psychomotor effects after desflurane and propofol anesthesia. Anesth Analg. 1996;83: 721–725.CrossRefPubMedGoogle Scholar
  27. 27.
    Grant SA, Murdoch J, Millar K, et al. Blood propofol concentration and psychomotor effects on driving skills. Br J Anaesth. 2000;85:396–400.PubMedGoogle Scholar
  28. 28.
    Sinclair D, Chung F, Smiley A. Recovery and simulated driving after ambulatory anesthesia. Can J Anesth. 2003;50:238–245.CrossRefPubMedGoogle Scholar
  29. 29.
    Chung F, Imasogie N, Prahbu A, et al. A follow up of ambulatory surgical patients with no escorts. Can J Anesth. 2005;52:1022–1026.CrossRefPubMedGoogle Scholar
  30. 30.
    Correa R, Menzes RB, Wong J, et al. Compliance with postoperative instructions: a telephone survey of 750 day surgery patients. Anaesthesia. 2001;56:481–484.CrossRefPubMedGoogle Scholar
  31. 31.
    Korttila K, Tammisito T, Ertama P, et al. Recovery, psychomotor skills, and simulated driving after brief inhalational anesthesia with halothane, or enflurane combined with nitrous oxide and oxygen. Anesthesiology. 1977;46:20–27.CrossRefPubMedGoogle Scholar
  32. 32.
    Korttila K, Linnoila M, Ertama P, et al. Recovery and simulated driving after intravenous anesthesia with thiopental, methohexital, propanidid, or alphadione. Anesthesiology. 1975;43:291–299.CrossRefPubMedGoogle Scholar
  33. 33.
    Sinclair DR, Chung F, Smiley A. General anesthesia does not impair simulator driving skills in volunteers in the immediate recovery period—a pilot study. Can J Anaesth. 2003;50:238–245.CrossRefPubMedGoogle Scholar
  34. 34.
    Chung F, Kayumov L, Sinclair DR, et al. What is the driving performance of ambulatory surgical patients after general anesthesia? Anesthesiology. 2005;103: 951–956.CrossRefPubMedGoogle Scholar
  35. 35.
    Amid PK. Driving after repair of groin hernia. BMJ. 2000;321:1033–1034.CrossRefPubMedGoogle Scholar
  36. 36.
    Tzabar Y, Asbury AJ, Millar K. Cognitive failures after general anaesthesia for daycase surgery. Br J Anaesth. 1996;76:194–197.PubMedGoogle Scholar
  37. 37.
    Canet J, Raeder J, Rasmussen LS, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesth Sand. 2003;47:1204–1210.CrossRefGoogle Scholar
  38. 38.
    Hadzic A, Arliss J, Kerimoglu B, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology. 2004;101:127–132.CrossRefPubMedGoogle Scholar
  39. 39.
    Hadzic A, Karaca PE, Hobeika P, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg. 2005;100:976–981.CrossRefPubMedGoogle Scholar
  40. 40.
    Ritchie ED, Tong D, Chung F, et al. Suprascapular nerve block for pain relief after arthroscopic shoulder surgery: is it effective? Anesth Analg. 1997;84:1306–1312.CrossRefPubMedGoogle Scholar
  41. 41.
    Liu SS, Strodtbeck WM, Richman JM, et al. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101:1634–1642.CrossRefPubMedGoogle Scholar
  42. 42.
    Ben-David B, Levin H, Solomon E, et al. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg. 1996;83:716–720.CrossRefPubMedGoogle Scholar
  43. 43.
    Santanen U, Rautoma P, Luurila H, et al. Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and nondural puncture headache. Acta Anaesthesiol Scand. 2004;48:474–479.CrossRefPubMedGoogle Scholar
  44. 44.
    Gold BS, Kitz DS, Lecky JH, et al. Unanticipated admission to the hospital following ambulatory surgery. JAMA. 1989;262:3008–3010.CrossRefPubMedGoogle Scholar
  45. 45.
    Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery-a prospective study. Can J Anaesth. 1998;45:612–619.CrossRefPubMedGoogle Scholar
  46. 46.
    Mattila K, Toivonen J, Janhunen L, et al. Postdischarge symptoms after ambulatory surgery: first week incidence, intensity, and risk factors. Anesth Analg. 2005;101: 1643–1650.CrossRefPubMedGoogle Scholar
  47. 47.
    Myles PS, Weitkamp B, Jones K, et al. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84:11–15.PubMedGoogle Scholar
  48. 48.
    Laffey JG, Carroll M, Donnelly N, et al. Instructions for ambulatory surgery-patient comprehension and compliance. Ir J Med Sci. 1998;167:160–163.CrossRefPubMedGoogle Scholar
  49. 49.
    Zvara DA, Mathes DD, Brooker RF, et al. Video as a patient teaching tool: does it add to the preoperative anesthetic visit? Anesth Analg. 1996;82:1065–1068.CrossRefPubMedGoogle Scholar
  50. 50.
    Chew LD, Bradley KA, Flum DR, et al. The impact of low health literacy on surgical practice. Am J Surg. 2004;188:250–253.CrossRefPubMedGoogle Scholar
  51. 51.
    Fung D, Cohen MM. Measuring patient satisfaction with anesthesia care: a review of current methodology. Anesth Analg. 1998;87:1089–1098.CrossRefPubMedGoogle Scholar
  52. 52.
    Ware JEJ, Snyder MK, Wright WR. Defining and measuring patient satisfaction with medical care. Eval Program Plan. 1983;6:247–263.CrossRefGoogle Scholar
  53. 53.
    Meterko M, Rubin H, Ware JE Jr. Patient judgements of hospital quality questionnaire. Med Care. 1990;9(suppl):S1–44. As cited in Ref 51. Fung D, Cohen MM. Measuring patient satisfaction with anesthesia care: a review of current methodology. Anesth Analg. 1998;87:1089–1098.Google Scholar
  54. 54.
    Klock PA, Roizen M. More or better: educating patients about the anesthesiologist’s role as perioperative physician. Anesth Analg. 1996;83:671–672.CrossRefPubMedGoogle Scholar
  55. 55.
    Dexter F, Aker J, Wright J. Development of a measure of patient satisfaction with monitored anesthesia care. Anesthesiology. 1997;87:865–873.CrossRefPubMedGoogle Scholar
  56. 56.
    Whitty PM, Shaw IH, Goodwin DR. Patient satisfaction with general anesthesia. Anaesthesia. 1996;51:327–332.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Frances Chung
    • 1
    • 2
  • Jeremy Lermitte
    • 1
    • 3
  1. 1.Toronto Western HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of AnesthesiaTorontoCanada
  3. 3.University Health NetworkTorontoCanada

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