From Aldrete to PADSS:

Reviewing Discharge Criteria After

Ambulatory Surgery
Heather Ead, BScN, RN

Nurses working in perianesthesia care areas use discharge scoring

criteria to complete patient assessments and ensure patient readiness
for discharge or transfer to the next phase of recovery. However, all
discharge criteria have both advantages and disadvantages. Com-
parative studies on the reliability of the different discharge criteria in
use are extremely limited. As the acuity of our aging population
increases, as well as the number of annual surgeries performed on an
outpatient basis, it is most timely to ensure that we are following
evidence-based discharge criteria.
© 2006 by American Society of PeriAnesthesia Nurses.

ALMOST A CENTURY has passed since the
surgeon Dr James Nicoll endorsed the benefits
of sending patients home to recuperate on the
same day of the operative procedure.1 Dr Ralph
Waters, an anesthesiologist during this same
time period, also supported this practice.2 Dr
Waters indicated that, by following certain am-
bulatory procedures, the patient could return
home a few hours postoperatively to recover.1,2
Today, patients continue to benefit from having
procedures done on an ambulatory basis. The
annual number of ambulatory surgeries per-
formed continues to grow, and growth in am-
bulatory surgery is projected to continue. Fifty
to 70% of all surgeries are performed on an
outpatient basis,3 and it is anticipated that in a
few years as much as 85% of surgeries will be
performed on an outpatient basis.4
Many advantages are associated with ambula-
tory surgery. Reduced health care–acquired in-
fections, hospital costs, and waits for bed avail-
ability, as well as improved patient comfort are
a few of the reported advantages of ambulatory
surgery.5 Due to faster-acting anesthetic agents
such as remifentanil and sevoflurane, improved
options in treating postoperative nausea and
vomiting (PONV)—as well as preemptive, mul-
timodal analgesia—patients recover faster.6
These patients can return home to continue
with late, phase-three recovery in the comfort
of their own homes.3,7,8
Also facilitating efficient and safe discharge are
clear and concise discharge criteria. The Aldrete
scoring system and the Post Anesthetic Dis-
charge Scoring System (PADSS) have received
widespread acceptance in assessing postanes-
thetic recovery.1,9 The Aldrete scoring system
originated in 1970 by Dr J. A. Aldrete; the
PADSS originated in 1991 by Dr Frances Chung
(Table 1).
As the popularity of ambulatory surgery grows,
appropriate discharge criteria must be followed
to ensure patient-centered care. With the acuity
Heather Ead, BScN, RN, is a Clinical Educator, PACU and
Day Surgery, Trillium Health Centre, Mississauga, Ontario.
Address correspondence to Heather Ead, BScN, RN, 3735
Densbury Drive, Mississauga ON L5N 6Z2, Canada; e-mail
address: head@thc.on.ca.
© 2006 by American Society of PeriAnesthesia Nurses.
1089-9472/06/2104-0005$35.00/0
doi:10.1016/j.jopan.2006.05.006

Journal of PeriAnesthesia Nursing, Vol 21, No 4 (August), 2006: pp 259-267 259

260
Table 1. Discharge Scoring Systems
The Aldrete Scoring Systemⴱ
Respiration
Able to take deep breath and cough ⫽ 2
Dyspnea/shallow breathing ⫽ 1
Apnea ⫽ 0
O2 saturation
Maintains ⬎92% on room air ⫽ 2
Needs O2 inhalation to maintain O2
saturation ⬎90% ⫽ 1
O2 saturation ⬎90% even with supplemental
oxygen ⫽ 0
Consciousness
Fully awake ⫽ 2
Arousable on calling ⫽ 1
Not responding ⫽ 0
Circulation
BP ⫾ 20 mm Hg preop ⫽ 2
BP ⫾ 20–50 mm Hg preop ⫽ 1
BP ⫾ 50 mm Hg preop ⫽ 0
Activity
Able to move 4 extremities ⫽ 2
Able to move 2 extremities ⫽ 1
Able to move 0 extremities ⫽ 0
ⴱInformation obtained from references 1,9,10,13-16,22-24,29
1,9,10,13,14,16,19,22-24,29
†Information obtained from references
of outpatient surgery increasing, the aging pop-
ulation, and expansion of inclusion criteria for
day surgery, it becomes even more significant
to have clear, evidence-based discharge criteria
in clinical use.10-12 The following article dis-
cusses the history leading up to current dis-
charge criteria, the modifications made to en-
sure continued practicality and accuracy, the
benefits and limitations with discharge criteria,
and the resulting implications to the perianes-
thesia nurse.
The History of Aldrete Scoring
and PADSS
How was today’s current discharge criteria de-
termined? Reviewing the history of discharge
criteria, postambulatory surgery is of interest to
nurses involved in perianesthesia care. This in-
cludes nurses in PACUs, day surgery/ambula-
HEATHER EAD
The Post Anesthetic Discharge Scoring System (PADSS)†
Vital signs
BP & pulse within 20% preop ⫽ 2
BP & pulse within 20–40% preop ⫽ 1
BP & pulse within ⬎40% preop ⫽ 0
Activity
Steady gait, no dizziness or meets preop level ⫽ 2
Requires assistance ⫽ 1
Unable to ambulate ⫽ 0
Nausea & vomiting
Minimal/treated with p.o. medication ⫽ 2
Moderate/treated with parenteral medication ⫽ 1
Severe/continues despite treatment ⫽ 0
Pain
Controlled with oral analgesics and acceptable to patient:
Yes ⫽ 2
No ⫽ 1
Surgical bleeding
Minimal/no dressing changes ⫽ 2
Moderate/up to two dressing changes required ⫽ 1
Severe/more than three dressing changes required ⫽ 0
.
.
tory care areas, ambulatory surgery centers
(ASCs), endoscopy, dental offices, and plastic
surgeons’ offices. Reviewing the history of post-
anesthesia scoring systems identifies the im-
provements that have been made over the
years, as well as reinforces the value of abiding
by discharge criteria to maintain high standards
of care.
The Aldrete scoring system, a modification of
the Apgar scoring system used to assess new-
borns, has been used in many PACUs since its
introduction 35 years ago.13 This system is de-
signed to assess the patient’s transition from
Phase I recovery to Phase II recovery, from
discontinuation of anesthesia until a return of
protective reflexes and motor function.14 At
most institutions, Phase I recovery occurs in the
PACU. Once Phase I recovery is completed,
DISCHARGE CRITERIA: ALDRETE TO PADSS
homeostasis has been regained. To assess the
patient’s transition from Phase II to Phase III
recovery, the PADSS is used.10 Phase II recovery
is judged to be complete when the patient is
ready for discharge home. Phase III recovery
continues at home under the supervision of a
responsible adult and continues until the pa-
tient returns to preoperative psychologic and
physical function.14
Both the Aldrete system and PADSS evaluate
five key parameters to ensure safe transfer or
discharge of the patient postoperatively. Pa-
tients achieving a total score of 9 or 10 are
considered fit for transfer or discharge to the
next phase of recovery. The individual institu-
tion indicates if such scores are necessary for
transfer or discharge, or if a score of 8 is accept-
able (Table 1).
The original Aldrete scoring system of 1970
used color as an indicator of oxygenation by
assessing the color of the patient’s mucous
membranes and nail beds. With the advent of
oximetry, the Aldrete scoring system was up-
dated in 1995 to include this technological im-
provement.15 Although monitoring the patient’s
mucous membranes and nail beds is still in-
cluded in the nurse’s assessment, oximetry is
a more reliable indicator of oxygenation.1
Before the clear objective, numerical scoring of
the Aldrete and PADSS, a number of psychomo-
tor tests were used to assess discharge readiness
postanesthesia.9 In the late 1960s, a modified
Gestalt test (the Trieger dot test) was proposed
to measure recovery. Patients demonstrated re-
covery by connecting a series of dots on paper
to form a pattern. The more dots the patient
missed, the lower their recovery score.9 Not
only was this test tedious in nature; it did not
account for the presence of dizziness, hypoten-
sion, pain, bleeding, nausea, vomiting, and
other parameters included in current discharge
scoring systems.
Other psychomotor tests that have been used
are reaction time tests, driving simulator tests,
261
peg board tests, and a Maddox wing test, which
involves a device to test extraocular balance.9
These psychomotor tests have limited value in
assessing discharge readiness, but can be useful
tools in conducting research.6,17
The R.E.A.C.T. assessment tool is another scor-
ing system that was developed in Chicago in the
early 1980s. This acronym includes the param-
eters of:
Respiration,
Energy,
Alertness,
Circulation, and
Temperature18
Several limitations have been observed with the
R.E.A.C.T. assessment tool. Its creators ac-
knowledge that it is not appropriate for moni-
toring acute changes such as the onset of oxy-
gen desaturation, dysrhythmias, or bleeding.18
This tool is recommended for use after such
problems have been resolved. This is a se-
rious limitation because cardiac and respi-
ratory complications occur more frequently
in the PACU than in ambulatory care ar-
eas.12,19 The R.E.A.C.T. scoring tool also
lacks a parameter to score oxygenation, a
parameter included in the Aldrete scoring
system.
Before numerical scoring criteria, clinical crite-
ria checklists were used to assess patient dis-
charge readiness. Although these checklists are
used today in conjunction with the Aldrete and
PADSS scoring systems, their use alone does
not permit quantification of discharge readi-
ness. The checklists also do not facilitate
follow-up quality assurance audits.4 Stan-
dard discharge criteria are listed in Table 2.
Although standard discharge criteria are useful
to assess discharge readiness, the criteria is
broad without specifications as to vital sign
ranges or expected pain levels. Therefore, such
guidelines should be used along with the PADSS
to ensure the patient is safe for discharge to
Phase III recovery.14
262
Table 2. Clinical Discharge Criteriaⴱ
● Stable vital signs for at least one hour
● Alert and oriented to time, place, and person
● No excessive pain, bleeding, or nausea
● Ability to dress and walk with assistance
● Discharged home with a vested adult who will remain
with the patient overnight
● Written and verbal instructions outlining diet,
activity, medications, and follow-up appointments
provided
● A contact person and circumstances that warrant
seeking the assistance of a health care professional
clearly outlined
● Voiding before discharge not mandatory, unless
specifically noted by physician (ie, urological
procedure, rectal surgery, history of urinary
retention)
● Tolerating oral fluids not mandatory, unless
specified by physician (ie, patient is diabetic, frail,
and/or elderly; not able to tolerate an extended
period of NPO status)
Abbreviation: NPO, nothing by mouth.
ⴱData from references 1,2,10,14.
Drinking and Voiding Before
Home Discharge
Requiring all patients to void and tolerate
oral fluids is no longer supported and has
been shown to lead to unnecessary patient
delays.1,4,9,14,20,22 A patient who has not
voided postoperatively, has no urge to do,
has no bladder distention, or is not at high
risk of urinary retention may be discharged
home if given clear guidelines on when to
seek medical assistance. Patients who are at
high risk of urinary retention are those who
have undergone a procedure involving the
pelvic or genitourinary system, rectal or
urological procedures, hernia repairs, had
urinary catheterization perioperatively,
have a history of urinary retention, or re-
ceived neuroaxial anesthesia.1,9,14,20,21 This
group of patients has a higher risk of urinary
retention and are generally required to void
before discharge.22
Current literature remains inconsistent regard-
ing the requirement to void after postneuroaxial
HEATHER EAD
anesthesia. Both neuroaxial and general anes-
thesia can interfere with the detrusor muscle
function and predispose the patient to urinary
retention.21 If the bladder becomes distended
while anesthesia is blocking the contraction
ability of the detrusor muscles, voiding function
can be impaired.22 The mechanism of urinary
complications is related to anesthetic agents
blocking parasympathetic fibers in the sacral
region of the spine, which control the muscles
of micturition.23 Gupta and others found that as
many as 17.5% of patients had postspinal uri-
nary retention.21 Kang and others found that
urinary complications occur in less than 1% of
spinal anesthetics.23 Urinary retention may
occur with elderly men, whereas urinary
incontinence can occur with female pa-
tients. Even with the low occurrence of
urinary complications, these problems usu-
ally subside in the PACU, and intermittent
urinary catheterization is rarely needed.23
The choice of opioid used with spinal anes-
thesia is a factor in postoperative urinary re-
tention. Hydrophilic opioids, such as mor-
phine, may cause urinary retention, whereas
lipophilic opioids, such as fentanyl are less
likely to cause this side effect.20
A suggested practice is for the patient to remain
in the ambulatory care area for another hour if
the patient is at risk of urinary retention and has
more than 400 mL of urine in the bladder
(determined by an ultrasonic bladder scanner),
or if bladder distention is present. If after one
hour the patient still has not voided, an inter-
mittent catheterization can be done.22 If the
patient is not at increased risk of urinary reten-
tion, discharge should not be delayed if postop-
erative voiding does not occur in the hospital.
Such patients are given clear discharge instruc-
tions on when to seek medical assistance, eg, if
they are not able to void at home eight hours
after discharge.14
Patients are no longer required to drink fluids
before discharge home. Current recommenda-
tions are that postoperative hydration status is
DISCHARGE CRITERIA: ALDRETE TO PADSS 263

assessed and managed in the PACU.6 Current Table 3. Criteria for Fast-Tracking After
practice guidelines set out by the American Ambulatory Anesthesiaⴱ
Society of Anesthesiologists Task Force on Post-
Level of Consciousness:
Anesthetic Care recommend that drinking clear
Awake and oriented 2
fluids should not be a part of a discharge pro- Arousable with minimal stimulation 1
tocol, but may only be necessary for selected Responsive only to tactile stimulation 0
patients, such as diabetics.6 Not abiding by such Physical Activity:
recommendations will unnecessarily delay dis- Able to move all extremities on command 2
charges, reduce patient satisfaction, and in- Some weakness in movement of extremities 1
crease the incidence of nausea and vomiting Unable to voluntarily move extremities 0
when patients are encouraged to drink to be Hemodynamic Stability:
discharged.1,4,9,14,16 Although the initial PADSS BP ⫾ 15% of baseline 2
of 1991 did include voiding and drinking in the BP ⫾ 30% of baseline 1
discharge criteria, the revised PADSS of 1993 BP ⫾ 50% of baseline 0
Oxygen Saturation:
removed these criteria to avoid unnecessary
Maintains value ⬎90% on room air 2
delays and support patient-focused care.24
Requires supplemental oxygen to maintain
oxygen saturation ⬎90% 1
Clinical practice and some clinical studies sup- Saturation ⬍90% with supplemental oxygen 0
port using the Aldrete scoring criteria to ensure Pain:
discharge readiness from Phase I recovery, and None/mild discomfort 2
PADSS to ensure discharge readiness from Moderate to severe, controlled with IV analgesics 1
Phase II recovery.4,9,14,15,19,24 Institutions Persistent to severe 0
should also have clear guidelines on dis- Emetic Symptoms:
charge criteria, and requirement for all pa- None/mild nausea with no active vomiting 2
tients to void or tolerate oral fluids should Transient vomiting controlled with IV
not be part of such a protocol.1,4,6,9,14,22,24 antiemetics 1
Persistent moderate to severe nausea & vomiting 0
Fast-Tracking/Bypassing the PACU Abbreviation: IV, intravenous.
ⴱData from references 2,3,7,14,25,26.
The practice of fast-tracking patients to the am-
bulatory care area— bypassing the PACU— has
been practiced in some institutions since the niques and short-duration anesthetics, there
late 1990s.25 With fast-tracking, patients must is inconsistent support in the literature sup-
meet discharge criteria to illustrate comple- porting its use.14,28 Not all patients are ap-
tion of Phase I recovery before transfer propriate for fast-tracking. In one study,
from the operating room to the ambulatory only 31% of patients were eligible for fast-
care area.26,27 The fast-tracking criteria sug- tracking.14 Thus, a large number of patients
gested by White26 appear to be a union of the still required traditional postanesthesia care
Aldrete scoring system and the PADSS. To in the PACU. The PACU needs to be staffed
meet fast-tracking criteria, the patient must appropriately to receive patients who are
score a minimum of 12 (maximum score is not eligible for fast-tracking; therefore cost
14), with no score ⬍1 in any parameter.26 As savings by reducing staffing in the PACU
mentioned previously, this scoring criterion could not be guaranteed.27 The Ontario
may vary slightly according to the facilities’ Perianesthesia Nurses Association (OPANA)
individual protocols (Table 3). Practice Standards indicate there is cur-
rently very little data addressing patient out-
Although fast-tracking is possible due to comes related to fast-tracking.28 Another
factors such as minimally invasive tech- concern regarding fast-tracking is that there
264
Table 4. Advantages and Limitations of Discharge Scoring Criteria
Advantages of Discharge Scoring Criteriaⴱ
1. A well designed clinical scoring system provides a
reliable guide for nursing assessment.
2. Using scoring criteria follows standards set out by the
JCAHO and OPANA.
3. The reliability of scoring criteria is superior to clinical
discharge criteria.
4. Scoring systems are efficient and user friendly for
varying age groups.
5. Individualized scoring promotes patient-focused care.
6. Scoring criteria (Aldrete and PADSS) are widespread
in acceptance, providing consistency among health care
providers.
7. Unnecessary delays related to lack of voiding or fluid
intake can be avoided.
8. Using scoring criteria follows the recommendations
of the CAS.
9. Scoring systems are practical, easy to retain and repeat
throughout the patient’s stay.
10. Progress is quantified, and the scores can be tracked
or used in patient’s stay.
11. Progress is quantified, and the scores can be tracked
or used in follow-up chart audits/studies.
12. The scoring criteria assess all parameters of recovery
to ensure patient safety and readiness to be transferred
to the next phase of recovery.
Abbreviations: JCAHO, Joint Commission on Accreditation of Health Care Organizations; OPANA, Ontario Perian-
esthesia Nurses Association; CAS, Canadian Anesthetists Society; MH, malignant hyperthermia.
ⴱInformation obtained from references 1,4,5,9-11,13-16,19,22-24,28.
†Information obtained from references 1,2,14,29.
is no one agreed-upon practice guideline or
definition of the factors involved in fast-
tracking.28 Further clinical studies are re-
quired for its validation and benefits.9 It is
clear that there is a need for caution in
implementing fast-tracking, and that a learn-
ing curve exists with this practice.
Advantages and Limitations
of Discharge Scoring Criteria
Although working in the perianesthesia area is
often demanding and hectic, it is important to
regularly review current processes to ensure
that up-to-date standards of care are in place.
HEATHER EAD
Limitations of Discharge Scoring Criteria†
1. A definitive tool that is sensitive to the patient,
surgical procedure, and anesthetic technique has
yet to be finalized.
2. Scoring systems do not include criteria for specific
requirements, eg, a required increased length of
stay if M.H. susceptible, patient at high risk of
urinary retention has not voided. In these cases,
additional guidelines need to be established and
followed.
3. The postoperative vital sign parameter may be
inaccurate if preoperative values were abnormally
high for the patient. (eg, elevated blood pressure
preoperatively, related to anxiety).
There are many benefits for both the patient
and nurse in consistently using evidenced-based
discharge scoring criteria. However, with all
discharge criteria, there are limitations. Table 4
illustrates how the benefits of using numer-
ical discharge criteria are more numerous
than the limitations. Using criteria such as
the Aldrete scoring system and the PADSS is
supported by the Joint Commission for Ac-
creditation of Healthcare Organizations
(JCAHO), the Canadian Anesthetists Society
(CAS), and OPANA.1,14,28 Using numerical
scoring is also user-friendly and easily re-
peated during the patient’s stay to monitor
DISCHARGE CRITERIA: ALDRETE TO PADSS
improvement. Tracking improvements in clin-
ical status allows a patient-focused approach,
and confirms when the patient is ready to be
transferred to the next phase of recovery.
Limitations exist that have important implica-
tions for nursing with any discharge criteria.
Although scoring criteria are reliable tools, they
do not replace the critical thinking or profes-
sional judgment of the nurse. For example, the
patient may fit all discharge criteria, yet the
surgeon indicates that the patient must stay a
minimum of four hours postoperatively be-
cause of susceptibility to malignant hyperther-
mia.12 Another example of a limitation is the
elderly postoperative patient who is frail, dia-
betic, has some renal insufficiency, and resides
a long distance from a medical facility. In this
case it is better to err on the side of caution, and
ensure the patient can tolerate oral fluids before
discharge because the preoperative health sta-
tus indicates that this patient may not tolerate
an extended period of “nothing-by-mouth” sta-
tus if unable to tolerate fluids at home. Long
distances to accessing medical assistance and
age are relative factors that the critical-thinking
nurse keeps in mind when using scoring sys-
tems to assess discharge readiness. Scoring sys-
tems focus on discharge goals; however, such
systems can still fail patients if we blindly look at
the scoring criteria.1
Other limitations to keep in mind are the occur-
rence of postoperative complications requiring
re-admission to the hospital. The complication
rate after ambulatory procedures remains low.
Most complications are transient, such as pain,
sore throat, and nausea. Some complications
can be managed before discharge. The rates of
unanticipated admissions after day surgical pro-
cedures range between 0.3 to 1.4%.29,30 Dis-
charge teaching is key to the patient and family
understanding which situations will warrant re-
turn to the hospital or further medical assistance.
Calculating scores on the vital sign parameters
of both the Aldrete scoring system and the
265
PADSS can be an area of uncertainty. Although
the patient’s vital signs may be within normal
range for age, the blood pressure should be
compared with that of preoperative value to
ensure the patient’s return to homeostasis.
However, if the preoperative value was abnor-
mally elevated because of anxiety or pain, ex-
pecting the postoperative blood pressure to be
within 20% of an elevated blood pressure may
not be appropriate. Again, an individualized pa-
tient assessment by the nurse and consultation
with the surgeon or anesthesiologist, as needed,
will confirm that the patient is suitable for dis-
charge in such situations. Discharge readiness
does not assume street fitness.14 If the patient
does not understand the activity restrictions
required as they continue Phase III recovery at
home, there is risk for overexertion and adverse
reactions occurring. Again, it is recognized that
scoring criteria are an important part of assess-
ing discharge readiness, but they must be used
with approved discharge criteria, health teach-
ing, and follow-up telephone calls. Using dis-
charge criteria as well as appropriate patient
selection for ambulatory surgery are key factors
to ensure the patient’s ability to meet discharge
criteria.28,29
Common Complications After
Ambulatory Surgery
Ambulatory surgery is safe, with adverse events
occurring at low rates, less than 2%.31 Cardio-
vascular events (such as hypotension, hyperten-
sion, and dysrhythmias) occur most frequently,
followed by respiratory events (such as laryngo-
spasm, bronchospasm, and oxygen desatura-
tion).31 Cardiac or respiratory comorbidities are
strongly associated with such postoperative
complications.5,28 Pain, PONV, and minor se-
quela such as sore throat and shivering, are
other concerns that arise after surgery.5
Follow-up telephone calls to the patient’s home
have an large role in ensuring safety throughout
late recovery5,28; concerns such as continued
PONV, pain, and bleeding can be addressed.
These phone calls can also confirm the patient’s
266
understanding and compliance to the verbal
and written discharge instructions provided.1,28
Follow-up phone calls can also be used in qual-
ity assurance studies.
Conclusion
The pillars of efficient, safe ambulatory surgery
include appropriate patient selection and timely
discharge.12,14 Assessment of the patient
with the aid of scoring criteria such as the
Aldrete scoring system and the PADSS can
facilitate safe transition of care throughout
the three phases of recovery. Chung, Chan,
and Ong demonstrated increased reliability
using PADSS versus a criteria checklist.10
The requirement to void and tolerate fluids
is no longer considered part of standard
discharge criteria.1,4,6,9,14,20,24
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1. Marley RA, Moline BM. Patient discharge from the ambu-
latory setting. J Post Anesth Nurs. 1996;11:39-49.
2. Fessey E. Implementing nurse-led discharge from day
surgery. Nurs Times. 2005;101:32-33.
3. Apfelbaum J, Walawander C, Thaddeus M, et al. Eliminat-
ing intensive postoperative care in same-day surgery patients
using short-acting anesthetics. Anesthesiology. 2002;97:66-74.
4. Beatty A, Martin D, Couch M, et al. Relevance of oral
intake and necessity to void as ambulatory surgical discharge
criteria. J Post Anesth Nurs. 1997;12:413-421.
5. The Joanna Briggs Institute. Management of the day sur-
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at: http://www.joannabriggs.edu.au/pdf/BPISSup2004.pdf. Ac-
cessed January 2006.
6. Silverstein J, Apfelbaum J, Barlow J, et al. Practice
guidelines for postanesthetic care. Anesthesiology. 2002;96:
742-752.
7. White P, Song D. New criteria for fast-tracking after outpa-
tient anesthesia: A comparison with the modified Aldrete’s
scoring system. Anesth Analg. 1999;88:1069-1072.
8. Casati A, Cappelleri G, Berti M, et al. Randomized com-
parison of remifentanil-propofol with a sciatic-femoral nerve
block for out-patient knee arthroscopy. Eur J Anesthesiol.
2002;19:109-114.
9. Marshall S, Chung F. Discharge criteria and complica-
tions after ambulatory surgery. Ambulat Anesth. 1999;88:
508-517.
10. Chung F, Chan V, Ong D. A post anaesthetic discharge
scoring system for home readiness after ambulatory surgery.
J Clin Anesth. 1995;7:500-506.
11. Friedman Z, Chung F, Wong D. Ambulatory surgery
adult patient selection criteria—A survey of Canadian anesthe-
siologists. Can J Anesth. 2004;51:437-443.
HEATHER EAD
However, because the scoring criteria is only
part of the discharge assessment, patients at
higher risk of complications such as dehydra-
tion and urinary retention can be assessed on a
case-by-case basis.6,14,22 Patients with such risks
would be instructed to return to the hospital if
postoperative concerns continue at home. Fol-
low-up phone calls are of particular importance
for high-risk patients to ensure patient-focused
care.
Once discharge protocols are established
and approved, it is mandatory that they are
consistently followed. By including dis-
charge scoring criteria, such as those out-
lined in this article, patients can continue to
benefit from ambulatory surgery and home
recovery with the comfort of their family’s
supervision.
12. Bryson G, Chung F, Cox R. Patient selection in ambula-
tory anesthesia—An evidence-base review: Part II. Can J
Anesth. 2004;51:782-794.
13. Suddarth B. Textbook of Medical-Surgical Nursing. Phil-
adelphia: Lippincott, William & Wilkins; 2004:303-306.
14. Kamming D, Chung F. What criteria should be used for
discharge after outpatient surgery? In Fleisher L, ed. Evidence-
Based Practice of Anesthesiology. Philadelphia: Saunders;
2004:247-252.
15. Aldrete JA. The post-anesthetic recovery score revisited.
J Clin Anesth. 1995;7:89-91.
16. Chung F. Discharge criteria—A new trend. Can J
Anesth. 1995;42:1056-1058.
17. Saunders LD. Recovery of psychological function after
anaesthesia. Int Anesth Clin. 1991;29:105-115.
18. Fraulini K, Murphy P. R.E.A.C.T.—A new system for
measuring postanesthesia recovery. Nursing. 1984;14:12-13.
19. Ang P, Pagan A, Lewis M. Determining patients’ readi-
ness for release from the postanesthesia recovery unit. AORN J.
2002;76:664-666.
20. Korhonen A, Valanne J, Jokela R, et al. Intrathecal hy-
perbaric Bupivacaine 3 mg ⫹ Fentanyl 10 ␮g, for outpatient
knee arthroscopy with tourniquet. Acta Anaesthesiol Scand.
2003;47:342-346.
21. Gupta A, Axelsson K, Thorn S, et al. Low-dose Bupiv-
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ASPAN 2008 National Conference

CALL FOR PROPOSALS

Proposals are now being accepted for presentations at the
ASPAN National Conference
May 4 – 8, 2008 Dallas, Texas
Lecture topics will be selected for the following categories:
Clinical Research Education
Geriatrics Pediatrics Preoperative Assessment
Leadership/Management Legal/Ethical Alternative/Integrative Therapies

To obtain a proposal packet,

please contact Carol Hyman at the ASPAN National Office:
877-737-9696 ext. 19 or chyman@aspan.org

Proposals must be postmarked by May 15, 2007.