Are discharge criteria changing?

The safe and expeditious conduct of ambulatory surgical care can succeed only by careful selection of patients and surgical procedures, appropriate intraoperative and postoperative anesthesia care, and prudent and timely discharge of patients. Practical discharge criteria or a postanesthesia discharge scoring system should be implemented in every ambulatory surgery center to ensure safe recovery and discharge after anesthesia. The PADSS is simple, practical, and easy to remember. It provides an uniform assessment of all patients, it may have added medicolegal value, and it establishes a routine of repeated reevaluation of home readiness. We recommend using the postanesthesia recovery score (Aldrete score) to evaluate the initial recovery of the patient. Once the Aldrete score is met, home readiness can be evaluated by the PADSS or modified PADSS (Tables 3 and 4). If the patient satisfies the criteria of the PADSS or modified PADSS, he or she can be discharged home. At the Toronto Hospital, we have discharged 30,000 patients home safely with the PADSS. However, any discharge criteria scoring system must be used with common sense and clinical judgment. Home readiness does not mean street fitness. Further studies on adverse outcomes after discharge and the return to normal function (e.g., work readiness) are warranted.