Discharge criteria--a new trend.

The safe, expeditious conduct of ambulatory surgical care can succeed only by careful selection of patients and procedures, appropriate intra- and postoperative anaesthetic management, and safe, timely discharge of patients. Discharge of patients should be achieved without compromising the quality of patient care. As the patients presenting for ambulatory surgery become more complex and compromised, and their surgical treatment more demanding, it is important to replace, or at least supplement, our existing qualitative, subjective method for evaluating patient discharge with a quantitative, objective technique to provide a simple and consistent method of determining home readiness. Practical discharge criteria or a postanaesthesia scoring system should be implemented in every ambulatory surgery centre to ensure safe recovery and discharge after anaesthesia. The Post-Anaesthesia Discharge Scoring System (PADSS) is simple, practical, easy to apply and to remember. In addition to permitting a uniform assessment of home readiness for patients, PADSS establishes a pattern of routine, repetitive evaluation of patients home readiness that is likely to contribute to improved patient outcome. In this way, PADSS also may have added medicolegal value. We recommend using the postanaesthesia recovery score (Aldrete score) to evaluate initial patient recovery. Once the Aldrete criteria are met, home-readiness can be evaluated by PADSS or modified PADSS in which input and output are eliminated (Table I, Table II). When the patient satisfies PADSS or modified PADSS criteria, he or she can be discharged home. We have discharged 30,000 patients safely home from our ambulatory surgical facility. Reduction in the length of stay in an ambulatory surgery unit by the prompt and safe discharge of patients can help to reduce costs and improve unit efficiency. For certain surgical procedures, ambulatory treatment is cheaper, even allowing for treatment failures and readmissions. However, we must remember that the application of any discharge criteria scoring system must include common sense, clinical judgment, and home-readiness of an outpatient does not assume street fitness.