Discharge Criteria in Day Surgery
The continuing increase in day surgery procedures has led to a number of issues, as nurses are challenged to provide the best possible care within a short time frame as well as to minimize the length of hospital stay. Utilizing the evidence from the literature, I am focusing especially on factors that lead to a delay in discharge and the introduction of guidelines to overcome the issue.
I presently work the day surgery unit of a new hospital and it is the only acute government hospital on an island of half a million inhabitants. The unit consists of 46 beds and a wide variety of procedures are performed, from gynaecological, orthopaedic, ophthalmology, laparoscopy, herniotomies, and pain management, excision of lesions or masses and endoscopy procedures.
In the last few years, the hospital administrators, put on pressure from the health authorities, have been tasked with bringing waiting lists, for elective surgery, down. However, as with many other hospitals, there is an acute problem of available inpatient beds, with a considerable number of scheduled operations cancelled.
In order to alleviate the increasing back-log and growing waiting lists, management elected to utilise the facilities available within my unit. Inevitably, this has put pressure on our unit and as a result, 30% of beds allocated to day surgery cases are being used for inpatient procedures, which in turn are creating a backlog on our list. There is an obvious need in finding a long-term solution and if I were to ask myself, as a nurse, what kind of strategy can be used in solving this problem, I would consider the following.
There is no doubt that the common problem with these delays and cancellations is the acute shortage of beds (Fessey, 2005). Focusing on the day surgery unit and my daily observations, I would highlight better bed management as a key area for alleviating this on going problem.
Through my daily observations, it seems evident that there is a delay in the discharging of patients and this therefore directly affects the number of available beds as well as creates inconvenience and dissatisfaction from the patients.
There are of course many factors that could delay the eventual discharge of a patient. However, I am of the opinion that better communication between nurses and doctors, together with the introduction of strict guidelines for nurses as well as better organisation could help to improve the situation considerably.
Every day I observe how patients fit for going home wait to be discharged for hours, sometimes even well into the evening. Through the current system, the final decision to discharge a patient, in this surgical unit, rests entirely with the consulting doctor. Unfortunately, there are no official guidelines that would allow and indeed empower, nurses to take the necessary action in discharging patients that would be deemed safely capable of being sent home. Therefore, a nurse’s assessments of the suitability of a patient-discharge are based on nurse’s experiences, knowledge, and personal beliefs (Kingdon &Newman, 2006).
There is the need of establishing valid desirable criteria to determine guidelines timing of discharging a patient but also focus in application and the importance of a discharge criteria (Stephenson, 1990).
The key question, which arises here, is: Does the implementation of Discharge Criteria System reduce the discharge delays in day surgery area?
In searching for qualitative evidence about the subject in discussion, I have used the following databases: MEDLINE through Pub Med – because it is contains a large size of data base, although it has more literature reviews this were useful in gathering data and very good for finding evidence of practice guidelines ; Cumulative Index of Nursing and Allied Health Literature(CINAHL) - being a very good tool to find a full text in all...
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