Being able to safely send patients home after surgery is core to the value proposition of ASCs — and reliable transportation is essential in a successful discharge.
Transportation may also be an overlooked aspect of discharge processes, according to an article published in Patient Safety in May. The article — a literature review conducted by risk and safety management analysts from ECRI — outlines concerns and recommendations from medical societies as to how patients can safely be transported home from ASCs.
Here are six takeaways from the article:
1. One study cited in the review found that outpatients who met discharge criteria after deep sedation still performed worse on driving simulators than their escort-drivers, affirming that the safest default remains discharge with a responsible adult after anesthesia or sedation.
2. The American Society of PeriAnesthesia Nurses defines a responsible adult as someone who is physically and mentally able to assist the patient and understand discharge instructions.
3. Escort requirements can create access barriers for patients who are unhoused or otherwise underserved, according to the authors. These barriers should be assessed during preoperative planning. For patients with health equity-related barriers, medications with rapid onset and short durations are recommended as best suited for facilitating discharge.
4. Rideshare and taxi services can facilitate discharge in some cases. One pilot study cited found that 100% of patients who used rideshare nonemergency medical transport were discharged following their procedure without incident.
5. However, rideshares do not fully address safety concerns. Commercial drivers may be unaware of the patient’s condition, may not react adequately to adverse events such as a fall, and are not required to demonstrate competence in a medical emergency. Additionally, impaired patients may be unable to communicate properly if an event occurs during transport. Rideshare services offer no guarantee a driver is willing or able to assist a patient requiring help.
6. The American Association of Nurse Anesthesiology recommends ASCs address the following in discharge policies:
- Determine whether a responsible adult is required to accompany the patient home and whether that adult must remain available to the patient for a set period after discharge.
- If a responsible adult is not available, define the organization’s requirements for discharge and transportation.
- Advise patients and responsible adults that sedation or anesthesia impairs the ability to operate a vehicle.
- Ensure patients plan for a responsible adult at the time of scheduling, and verify the plan before the procedure.
- If the patient is not a candidate for unaccompanied discharge, determine in advance whether medical transportation can be arranged, whether the patient should be admitted for observation, or whether the procedure should be rescheduled.
- Develop a specific discharge consent form for unaccompanied patients documenting the discussion of risks and the patient’s acceptance of those risks.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.