Criteria for Discharge after day care surgery

All patients must be evaluated prior to discharge from PACU and discharge criteria are established depending whether the patient is going to ICU, regular ward, outpatient department or directly to home
Mandatory stay in PACU for specified time is not required,patient are observed for their ability to protect airways with no respiratory depression and mental function is clear.

Evaluation of the patient in PACU for discharge is under the following guidelines

 Patients should be alert and oriented or mental status returned to baseline.
   2.     A minimum mandatory stay is not required.
   3.     Vital signs should be stable and within acceptable limits.
   4.     Discharge should occur after patients have met specified criteria.
   5.     Use of scoring systems may assist in documentation of fitness for discharge.
   6.     The requirement to urinate before discharge and drink and retain clear liquids should not be part of a routine discharge protocol although they may be appropriate for selected patients.
   7.     Outpatients should be discharged to a responsible adult who will accompany them home.
   8.     Outpatients should be provided with written instructions regarding postprocedure diet, medications, activities, and a phone number to call in case of emergency.

Two Most Commonly Used Postanesthesia Care Unit Discharge Criteria Systems

MODIFIED  ALDRETE SCORING SYSTEM POSTANESTHETIC DISCHARGE SCORING SYSTEM Respiration Vital signs 2 = Able to take deep breath and cough 2 = BP + pulse within 20% preop baseline 1 = Dyspnea/shallow breathing 1 = BP + pulse within 20–40% preop baseline 0 = Apnea 0 = BP + pulse >40% preop baseline O2 saturation Activity 2 = Maintains Spo2 >92% on room air 2 = Steady gait, no dizziness or meets preop level 1 = Needs O2 inhalation to maintain O2 saturation >90% 1 = Requires assistance 0 = O2 saturation <90% even with supplemental oxygen 0 = Unable to ambulate Consciousness Nausea and vomiting 2 = Fully awake 2 = Minimal/treated with PO medication 1 = Arousable on calling 1 = Moderate/treated with parenteral medication 0 = Not responding 0 = Severe/continues despite treatment Circulation Pain 2 = BP ± 20 mm Hg preop Controlled with oral analgesics and acceptable to patient: 1 = BP ± 20–50 mm Hg preop 2 = Yes 0 = BP ± 50 mm Hg preop 1 = No Activity Surgical bleeding 2 = Able to move four extremities voluntary or on command 2 = Minimal/no dressing changes 1 = Able to move two extremities 1 = Moderate/up to two dressing changes required 0 = Unable to move extremities 0 = Severe/more than three dressing changes required Score ≥9 for discharge Score ≥9 for discharge BP, blood pressure; PO, oral. Controlling post operative pain,controlling nausea and vomiting and re-establishing normothermia. Patients in majority meet the above criteria within 60 minutes and in addition to the above pateint receiving regional anesthesia should show signs of proprioception,sympathetic,bladder resolution and motor blockade Day care cases should be further evaluated for home readiness and complete psychomotor recovery. All out patients shouls be discharged home in the company of a responsible adult and with written post operative notes and emergency help details and perform routine follow up.