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

Abstract

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. AimsThe aim of this article is to explore the reasons why some adult patients are not suitable for discharge following day surgery. MethodsA 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. FindingsThe 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. ConclusionRecommendations 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. day surgery, discharge, delayed discharge, post-operative nausea and vomiting, post-operative pain, surgical delay, theatre delays

Wearable-Based Mobile Health App in Gastric Cancer Patients for Postoperative Physical Activity Monitoring: Focus Group Study

“…One study investigating factors associated with early discharge of patients with GC undergoing gastrectomy found that several factors, such as improved PA, laboratory variables, minimally invasive surgery, and body temperature, could predict early discharge [43]. For the patients undergoing surgical procedures other than gastrectomy, the reports also supported the relationship between improved PA and early discharge [44,45]. Our study suggested that the surgical staff should regard PA as an important clinical parameter, which has previously been long ignored as research is often hindered by the challenge of adapting an easy, valid, and reliable measure to record PA [6].…”

Role of patient education in postoperative pain management

“…Pain is a common reason for hospital readmission after surgery (Helgstrand et al 2011, Clement et al 2013, and may delay discharge following day care surgery (Rae 2016). Importantly, inadequate pain management after surgery can increase the risk of chronic postoperative pain (Joshi and Ogunnaike 2005).…”

Adopting the day surgery default in the provision of lumbar discectomy and decompressive surgery

“…Effective postoperative pain management is a prerequisite of successful day surgery, and it is arguably the most challenging issue. Uncontrolled pain is typically one of the main reasons for delayed discharge in day surgery (Mitchell 2004, Rae 2016. Similarly, moderate to severe pain is commonly reported following discharge after day surgery (Elaqoul et al 2017) and previous studies have estimated that more than half of patients experience this level of pain in the first 24 hours of being home (Townsend & Cox 2007).…”