Using Clinical-Based Discharge Criteria to Discharge Patients After Ophthalmic Ambulatory Surgery Under General Anesthesia: An Observational Study.

PURPOSE: To verify the feasibility of the clinical-based discharge (CBD) criteria and identify the reasons of long postanesthesia care unit length of stay (PACU-LOS) for ophthalmic ambulatory surgical patients under general anesthesia. DESIGN: A prospectively observational study conducted at a tertiary eye center in China. METHODS: Medical records were collected from patients admitted for strabismus ambulatory surgery under general anesthesia from September 2018 to March 2019. The patients were discharged home once met the CBD criteria based on a combination of the modified Aldrete's scoring system and Chung's Post-Anesthetic Discharge Scoring System. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate logistic regression was applied to identify the factors relating to late discharges. FINDINGS: All patients (N = 400) were safely and successfully same-day discharged home as none of the patients informed severe emergency events or unanticipated readmission. Nine displayed discharge delays mainly because of mild postoperative nausea and vomiting (PONV) although met the discharge criteria. About 85.5% of patients were discharged within a PACU-LOS of 150 minutes, 379 (94.8%) were within 180 minutes, and the cutoff time in PACU-LOS was 150 minutes. Multivariable analysis indicated that sevoflurane anesthesia and the presence of PONV were related to late discharges (PACU-LOS of greater than 150 minutes, all P < .05). CONCLUSIONS: The CBD criteria can efficiently and safely guide the ophthalmic ambulatory surgical patients to discharge home on the same-surgery day, whereas sevoflurane anesthesia and the presence of PONV are associated with a relatively long PACU-LOS.

[The role of the urology nurse in prehabilitation and same-day discharge robot-assited radical prostatectomy programs]. / Le rôle de l'IDE dans l'éducation thérapeutique avant opération et la mise en place d'un programme de prostatectomie totale robotique en ambulatoire.

INTRODUCTION: The purpose of this article is to explain the role of urology nurse in prehabilitation and same-day discharge programs for robotic radical prostatectomy. METHODS: This article is based on the analysis of the literature and the experience of our center. RESULTS: In order to prepare patients for outpatient surgery, urology nurse plays a key role during prehabilitation journeys. Two weeks before the operation, the healthcare teams (nurses, anesthetists, physiotherapists, etc.) organize workshops to explain to patients the operation course and post-operative care in order to allay any anxieties. Individual and group interviews, in specific workshops (compression stockings, urinary catheter, sexology) are organized in particular with urology nurse to answer all patients' questions. In association with enhanced recovery after surgery pathway, these programs improve the patient experience and satisfaction as well as peri-operative outcomes, and allows the development of an outpatient surgery program which currently represents approximately one third of surgeries. CONCLUSION: The implementation of perioperative protocols including prehabilitation improves the early results of robotic total prostatectomy, but also the patient experience. The urology nurse has a key role to play during these patient education days and in the preparation, information, support and follow-up of the patient, since the prehabilitation journey until the patient leaves the outpatient clinic.

Patients' experience of mood while waiting for day surgery.

AIMS AND OBJECTIVES: The aim was to describe the moods experienced by people waiting for day surgery. BACKGROUND: Except for anxiety, there is a lack of knowledge about the moods experienced by patients while waiting for day surgery, as well as the impact of mood during the perioperative period. Preoperative anxiety is common and has multiple negative effects. A deeper knowledge of preoperative moods and how they are experienced is needed and may be useful for improving perioperative care. DESIGN: Qualitative descriptive design. METHODS: Qualitative semi-structured interviews (n = 20) with adults waiting for day surgery in a Swedish university hospital. Data were analysed with inductive content analysis. RESULTS: The informants described a variety of moods and mood-influencing reasons. The main category that emerged was, 'feeling hope about regaining health as a help to balance mood' regardless of mood. This category was abstracted from the generic categories 'experiencing a harmonious mood' and 'experiencing a shifting mood'. The subcategories were 'feeling calm and at ease despite concerns and fear,' 'experiencing expectation,' 'feeling trust and confidence,' 'shifting between expectancy and anxiety,' 'feeling vulnerable and exposed, and 'feeling uncertainty'. CONCLUSIONS: The findings contribute to the knowledge about that regardless of mood, feeling hope about regaining health may help patients to balance their mood during the waiting period. RELEVANCE TO CLINICAL PRACTICE: The results can have implications with respect to developing and improving preoperative care, such as having clinicians extend offers of individual assistance and information during the waiting period to patients experiencing shifting mood. Instilling hopefulness in patients who are waiting for day surgery by means of clinical staff attitudes and interactions may help patients to develop healthy coping strategies and thereby improve their physical and emotional well-being.

Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review.

BACKGROUND: Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION: Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS: An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS: Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION: The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.

Home recovery following day surgery: a patient perspective.

AIMS AND OBJECTIVES: To investigate aspects of care potentially most influencing home recovery following day surgery. BACKGROUND: Elective surgery undertaken on a day-case basis is expanding. Many medical aspects of recovery have been investigated although less is known about the psychosocial view of postdischarge recovery. Greater insight into such issues is required for the development of a more coordinated nurse-led approach. DESIGN: Cross-sectional questionnaire. METHOD: As part of a larger study, questionnaires were distributed to 2401 adult patients on the day of operation (September 2010-October 2011) to examine patients' experiences of psychosocial recovery. Participants were requested to complete and return the questionnaire by mail one week after surgery with 684 returned. RESULTS: Eighty-five per cent were fully prepared for all events during home recovery. Satisfaction with pre- and postoperative surgical information was high although less so anaesthetic information. Using factor analysis, preoperative information, pain management, postdischarge information, anxiety management, postoperative nausea and vomiting, help and rest once home were central features. Multiple regression analysis demonstrated pre- and postoperative information provision to have a statistically significant positive association with patients' being 'fully prepared for all events during home recover'. Unsatisfactory pain management, increased anxiety and reduced help once home had a statistically significant negative association with patients' being 'fully prepared for all events during home recovery'. CONCLUSION: Focusing on the delivery of surgical and anaesthetic information, managing pain and anxiety and ensuring support once home may help to enhance recovery. A more comprehensive plan embracing such aspects could help enhance the day surgery patients' experience. RELEVANCE TO CLINICAL PRACTICE: Increased satisfaction and surgical/anaesthetic information are central to the continued success of minimal-stay surgery. A broader hospital/home strategy is required as too frequently nursing care can become fragmented between the preoperative outpatient visit, preassessment, day of surgery and postoperative outpatient visit.

Small interventions in outpatient surgery: Project of Advanced Nursing Skills.

The research analyzes data on the impact of the introduction of the figure nursing with advanced skills, "Advanced Skills" , in diagnostic and therapeutic surgical clinics within the Hospital of Piacenza. This is the application of the testing on the Project of Nursing "Skills"on advanced minor surgery "Minor Surgery", an outpatient procedure. They were given the satisfaction questionnaires to users and to the medical and nursing staff of the USL in Piacenza. The aim of the study was to verify the contention of the literature about the usefulness of an increased use of nursing skills within an ambulatory surgery to improve the quality of care and consequently to a higher user satisfaction. In light of the findings of the research, the ' impact of the implementation of the Project Advanced Nursing Skills has been positive, both among users is that health care providers. For a functional and effective management of the surgery may be useful to train a new nursing characterized by the possession of "Advanced Skills" whose "mission" is to develop more knowledge, share knowledge, as well as to foster innovation organizational and management to meet the demands of public health.

An alternative outpatient care model: postoperative guest suite-based care.

BACKGROUND: Patients recovering from outpatient surgery are responsible for managing their pain, managing ambulation, and even implementing thromboembolism prophylaxis after discharge. Because of the importance of postoperative care to prevent complications, a model of care that helps a patient transition to independent self-care could provide optimal results. OBJECTIVES: The authors investigated the safety and morbidity rate for patients who underwent body contouring procedures and overnight care at an attached, nurse-staffed guest suite facility. METHODS: A retrospective review was conducted of 246 patients who underwent major body contouring and who stayed at least 1 night in the guest suite facility. Major complications included a return to the operating room within 48 hours, major wound infection, and unplanned hospitalization within 48 hours. Minor complications included any postsurgical effect necessitating unplanned physician intervention within the first 30 days. Univariate analyses correlating patient characteristics and complication rates were conducted, as well as comparison of complication rates among same procedures reported in the literature. RESULTS: The complication rate (major and minor complications) was 25.20%. Surgical site infection occurred in 8.13% of patients. The most common wound complication was erythema around the incision site (12.20%). Death, deep vein thrombosis, or pulmonary embolism did not occur. Comparison with relevant results reported in the literature indicated a significant reduction in the occurrence of postoperative venous thromboembolism. CONCLUSIONS: Patient education after surgery is essential to healing and adequate care. The guest suite model provides improved care and education for the patient and family postsurgery by addressing some of the known risk factors of plastic surgery. LEVEL OF EVIDENCE: 4.

A descriptive survey of the information needs of parents of children admitted for same day surgery.

Going to the hospital for surgery is an event that most people may find daunting. Anticipation of the unknown, lack of control over events and unfamiliarity with the environment may result in feelings of anxiety and stress. This research paper used a quantitative descriptive survey to establish the information needs of parents of children admitted for same day surgery. The main aims of this study were to establish what information parents had received prior to their child's admission for same day surgery, and how they perceived this information. It also determined what other information they required. The findings demonstrated that the majority of parents in this study were satisfied with the information they had received. However they wanted further advice on the waiting times involved, the equipment used in the operating room department, pain relief and the procedures in the recovery room.

Understanding people's experience of vitreo-retinal day surgery: a Gadamerian-guided study.

AIM: This paper is a report of a study that aimed to understand the individual's experience of day surgery for repair of vitreo-retinal pathology. BACKGROUND: Day surgery evolved as a global phenomenon in response to tensions existing between community demand for health-care services and fiscal limitations. Since then vitreo-retinal surgery has been routinely performed as day surgery. Whilst studies have reported on patients' experience's following inpatient surgery, there has been limited investigation of vitreo-retinal day surgery from the patient's perspective. METHODS: In-depth unstructured interviews with 18 people were conducted between July 2006 and December 2007. Data analysis using philosophical hermeneutic techniques enabled a co-constructed understanding, where, the 'conditions of understanding' as described by Gadamer were established. FINDINGS: Guided by a Gadamerian approach to analysis, four constitutive themes were identified: 'the physical Self', 'the psychological Self', 'the historically located Self' and 'the Self located in the community'. Within each theme the participant's positive and negative experiences were understood in the context of human need, and gaps in nursing care became illuminated. These experiences included: pain, nausea, problematic self-care and psychological angst. CONCLUSION: Insights into the experience of vitreo-retinal day surgery, gained from this study can be used to inform nurses planning care for people with vitreo-retinal pathology. Nursing care must address broader patient needs that span multiple human domains, particularly when vision has been threatened by complex pathology.

Short hospital stays and new demands for nurse competencies.

Short hospital length of stays present new challenges for nurse competencies. The purpose of this study was to describe Finnish nurses' self-assessed level of competencies and their actual use in the ambulatory surgery setting. A cross-sectional descriptive design was used, and the data were collected electronically using the Nurse Competence Scale. Statistical methods were used for analyses. The nurses self-assessed level of competence items ranged from moderate to excellent along with the increased frequency of using competencies. Statistically significant relationship between the level competence and age, work experience, work rotation and permanent position were found. The findings indicate that patient-centred education and ensuring of patients' well-being and safety are the most essential competencies in this setting. Managerial intervention can be focused to increase nursing competencies in these areas.

The role of anxiolytic premedication in reducing preoperative anxiety.

Prevention of preoperative anxiety with anxiolytic premedication is associated with improved preoperative outcomes in surgical patients. The objective of the authors' study was to evaluate the percentage of surgical patients that are prescribed premedication for preoperative anxiety before their anticipated surgical procedure. A prospective study was carried out by theatre nursing staff in the theatre reception bay of a university teaching hospital. A questionnaire was designed to record the number of patients that described symptoms consistent with preoperative anxiety. The number of patients that had been offered anxiolytic premedication for preoperative anxiety was also recorded. Consent was obtained from 115 consecutive surgical patients (male, n=52; female, n=63). Of these, 66% (n=76) reported anxiety before their surgical procedure (male: n=27, female: n=49). Premedication with a low-dose benzodiazepine was prescribed by an anaesthetist in 4% of cases (n=5). Patients that received premedication preoperatively reported effective relief of their anxiety symptoms This study demonstrates that preoperative patient anxiety is highly prevalent. The authors' findings suggest that premedication with anxiolytic pharmacological therapy may be an underused therapeutic resource for managing preoperative patient anxiety.

Anxiety management in minimal stay surgery.

An increase in minimal-stay surgery has reduced opportunities for nurses to discuss patients' anxieties about anaesthesia and the procedures that they will undergo. To allay patient anxieties and therefore promote a good recovery from surgery, nurses need to put in place a planned programme of information provision for patients. They are in a good position to promote patients' feelings of control and ability to cope, and help them to think positively.

Randomized clinical trial testing efficacy of a nurse-coached intervention in arthroscopy patients.

BACKGROUND: Emerging data suggest limited patient preparation for ambulatory surgery, decreased access to healthcare providers postoperatively, increased patient and family anxiety, and increased patient suffering. Thus, there is a need for nursing interventions to improve the postoperative experience for patients and families. OBJECTIVE: The purpose of this study was to test the hypothesis that ambulatory arthroscopic surgery patients who receive a nurse-coached telephone intervention will have significantly less symptom distress and better functional health status than a comparable group who receive usual practice. METHODS: The study sample in this randomized clinical trial with repeated measures was 102 participants (52 in the intervention group and 50 in the usual practice group) drawn from a large academic medical center in the Northeast United States. Symptom distress was measured using the Symptom Distress Scale, and functional health was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey General Health Perceptions and Mental Health subscales. RESULTS: Multivariate analysis of covariance, with three repeated measures of the Symptom Distress Scale (baseline, 72 hours postsurgery, and 1 week postsurgery) and five covariates, was used to test the hypothesis. After removal of the covariate influence, intervention participants had significantly less symptom distress at 72 hours and 1 week postsurgery and significantly better overall physical and mental health at 1 week postsurgery than those who received usual practice. DISCUSSION: The findings suggest that telephone calls from nurses during the immediate postoperative period resulted in improved patient outcomes, namely, less symptom distress and better physical and mental health states. In future research, the study sample should be expanded to older and more diverse patients.

Patients' experiences of day surgery: a Parsonian analysis.

AIM: The aim of the study was to explore patients' experiences of day surgery using a sociological framework of analysis. BACKGROUND: Although day surgery has increased globally in the last 20 years, little applied sociological research has been undertaken in this area. METHOD: The Glaserian methodology of Grounded Theory was used. Semi-structured interviews were conducted with 145 patients and 100 carers on three occasions from 2004 to 2006. Analysis of the data involved line-by-line analysis, compilation of key words and phrases (codes) and constant comparison of the codes until core categories were identified. FINDINGS: A major category to emerge from the data was the ambiguity presented to patients in relation to the sick role. Of concern to patients was society's attitudes, which seem to deny to day surgery patients full entitlement to the privileges associated with the sick role. Day surgery patients wanted to feel comfortable in a role that was socially acceptable--the sick role. However, many patients actively resisted this role, and this could have implications for recovery. A large number of patients wished for a limited ascription of the sick role, whilst a minority actively sought to acquire this role. CONCLUSION: The importance of nurses in providing supportive, psychological care, and ensuring patient and carer understanding of what day surgery entails cannot be overstated. Day surgery personnel should teach that day surgery is not minor surgery and that recovery times may be protracted, during which patients will need support.

Intraprocedural evaluation of comfort for sedated outpatient upper endoscopy and colonoscopy: the La Crosse (WI) intra-endoscopy sedation comfort score.

Patient comfort is often assessed during gastrointestinal procedures to guide sedation. There are, however, no validated scales appropriate for routine comfort assessment. This study validated a single-item La Crosse (WI) intra-endoscopy sedation comfort score (L-WISC) by determining interobserver agreement and correlation with patient outcomes. The study was conducted in prospective outpatient cohorts of patients undergoing outpatient esophagogastroduodenoscopy and/or colonoscopy at a regional healthcare medical center endoscopy unit. In Phase 1, independent assessments of 100 patients' intraprocedural comfort by the endoscopist and nurse determined interobserver agreement. In Phase 2, nurses assessed 200 patients, who were provided surveys to self-report their comfort 2 weeks postprocedure. In Phase 1, there was fair interobserver agreement (weighted κ = 0.36, with 95% confidence intervals [CI] [0.19, 0.53]). After L-WISC revisions, Phase 1 was repeated with moderate agreement (weighted κ = 0.45; 95% CI [0.31, 0.60]). In Phase 2, using the revised score, there was poor agreement (weighted κ = 0.098; 95% CI [-0.0020, 0.20]) between nurses' and patients' scores. The L-WISC is the first intraprocedural gastrointestinal comfort score appropriate for routine use to be validated with interobserver agreement and correlation with patient outcomes. It has reproducibility between endoscopists and nurses. It does not predict patient recollection of sedation comfort, but it remains unclear whether such prediction is possible with the use of amnestic sedatives. The L-WISC provides standardized levels of patient comfort to guide sedation titration routinely during outpatient endoscopy.

Nurse practitioner role in preparing families for pediatric outpatient surgery.

Due to medical advances in surgery and anesthesia and cost of hospital stays, more elective pediatric surgical procedures are being performed in outpatient settings. One proposed advantage of outpatient surgery is decreased anxiety or a shorter period of anxiety for pediatric patients and their families because they are able to go home shortly after the surgery. A literature review was conducted to describe anxiety experienced by pediatric patients and their families in the outpatient surgery setting and to explore ways to decrease that anxiety. Both children and parents reported not feeling emotionally and educationally prepared for outpatient surgery. Developmentally appropriate pre-surgical educational programs and parental involvement in the surgical experience can help alleviate the anxiety of both children and parents during the pediatric surgical experience. Nurse practitioners (NPs) are currently being used in pre-operative outpatient settings to conduct physical examinations and provide pre-op education. Pre-op education programs provided by NPs are beneficial in decreasing the anxiety state among children and parents prior to surgery.

Female stress urinary incontinence: office-based urethral bulking agent procedure.

Urethral bulking agents have been used extensively to treat women with stress urinary incontinence due to intrinsic sphincter deficiency. This article presents the authors' experience with one of the currently approved urethral bulking agents, Macroplastique, in a urology office setting.

Day case gastrostomy placement for patients in the community.

The numbers of patients receiving home enteral feeding via a gastrostomy is increasing, with placement of the gastrostomy often being undertaken as a hospital day case. There are a number of benefits to the patient having the procedure in this way, however, problems may arise if a comprehensive assessment is not undertaken prior to the procedure, there is a lack of communication between hospital and community services, or inappropriate or inadequate training. It is essential to ensure that the transfer of care from acute hospital to community services is thorough to minimize these potential problems. This article aims to address some of the pitfalls that may occur when patients who require home enteral feeding are admitted to hospital for the placement of a gastrostomy and discharged from hospital into their own homes or into a care home the same day. Discussion will centre around the timing and assessment for gastrostomy placement, managing the risk of refeeding syndrome, devising a suitable feed regime, obtaining prescriptions, setting up community services and monitoring the patient's progress.

Nurse-facilitated discharge for children and their families.

This article explores the introduction of nurse-facilitated discharge in one children's day care unit. It highlights how a need for change to the discharge procedure was established and how the practice was developed, successfully introduced and subsequently reviewed. The author concludes that the process has improved patients' experience with families no longer waiting hours for a consultant to discharge them. It has relieved bed pressures and empowered staff to extend the process to inpatient children's wards.