Outpatient Dismissal With a Responsible Adult Compared With Structured Solo Dismissal: A Retrospective Case-Control Comparison of Safety Outcomes

Abstract

ObjectiveTo test the hypothesis that patients dismissed alone in a sedation dismissal process (SDP) have no greater risk of adverse outcome compared with those who were dismissed with a responsible adult.Patients and MethodsWe compared 2441 SDP patients undergoing 2703 procedures with 4923 unique control patients who underwent 5133 procedures between June 1, 2012, and March 31, 2017.ResultsThe rate of unplanned readmission related to the procedure was 0.11% (n=9), and there was no difference between SDP (0.07%) and controls (0.14%). Similarly, there was no difference in complication rates between SDP patients and controls when restricting to “all causes” unplanned readmissions within 24 hours and unplanned readmissions related to procedure.ConclusionWith proper preparation, short-acting anesthetic/sedation medications, and sound clinical judgment, the presence of a responsible adult escort is not associated with reduced risk following discharge after ambulatory anesthesia. This practice may lessen the hardships reported by patients in needing to obtain an escort and the inconveniences and delays experienced by ambulatory procedural facilities when patients arrive without a designated escort.

Timely Colonoscopy After Positive Fecal Immunochemical Tests in the Veterans Health Administration: A Qualitative Assessment of Current Practice and Perceived Barriers

“…Social barriers, including the absence of a companion or reliable transportation after procedural sedation, were cited by both high- and low-performing sites. Similar problems in other institutions and potential solutions have been described ( 25 , 26 ). The VA developed an internal postsedation care and discharge toolkit in 2019 specifically to address these issues, although the potential effect of the toolkit would not be reflected in our findings because it occurred after the study period.…”

Patient Selection for Adult Ambulatory Surgery: A Narrative Review

“…Although this is outside the focus of this review, the debate regarding the need for a responsible escort is ongoing, as the evidence regarding the safety of discharging a patient home alone is equivocal. 21–23…”

“…Although this is outside the focus of this review, the debate regarding the need for a responsible escort is ongoing, as the evidence regarding the safety of discharging a patient home alone is equivocal. [21][22][23] The American Society of Anesthesiologists (ASA) recommends that a responsible individual receive discharge instructions and escort the patient who has received sedation or general anesthesia. 24,25 Likewise, regulatory agencies such as Accreditation Association for Ambulatory Healthcare (AAAHC) and The Joint Commission (TJC) recommend that the patient who has received moderate/deep sedation or general or regional anesthesia be discharged in the company of a designated responsible individual unless exempted by the attending physician.…”

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

“…German patients who were sedated with midazolam and an opioid however scored worse on both the NCT and the driving simulator 2 hours post-sedation. American and Japanese experience suggests patients sedated with drugs with a short halflife may be safely discharged without an accompanying person, 117,118 and that they may drive home safely within a few hours of sedation. 117 Patients who have received sedation should be discharged with a responsible person and avoid operating heavy machinery, driving or signing any legally binding documents for a period.…”