Discharge Criteria

Discharge Criteria: Vitals First - The Stability Check

• Core Vital Signs: Stable & within acceptable limits. 📌 (BP, HR, RR, SpO2, Temp)
  • Blood Pressure (BP): Near baseline (e.g., within ±20% of pre-op).
  • Heart Rate (HR): 50-120 bpm (stable, patient-dependent).
  • Respiratory Rate (RR): 10-24 breaths/min, unlabored.
  • SpO2: ≥92-94% on room air (or patient's baseline).
  • Temperature: Afebrile (e.g., 36.0°C - 37.5°C).
• Pain Control: Adequately controlled (e.g., VAS ≤ 3-4/10).
• PONV Management: Minimal; no active vomiting in last 30 min.
• Surgical Site Assessment: No active/excessive bleeding or swelling.

⭐ Vital signs should be stable and recorded for at least 30 minutes (often two consecutive sets of readings) prior to discharge from PACU Phase I.

Discharge Criteria: Patient Factors - Awake & Able

• Mobility & Ambulation:
  • Patient can ambulate safely, consistent with their pre-procedure baseline.
• Oral Intake:
  • Tolerates oral fluids without experiencing significant nausea or vomiting.
• Voiding (Procedure-Dependent):
  • Has voided spontaneously, especially important after spinal/epidural anesthesia or relevant surgeries (e.g., urologic, pelvic).
• Cognitive Function:
  • Fully oriented (time, place, person).
  • Able to understand and retain discharge instructions; judgment is unimpaired.
• Respiratory Status:
  • No signs of respiratory depression; maintains stable respiratory rate and oxygen saturation (SpO2).

⭐ Post-Ambulatory Discharge Scoring Systems (PADSS) are commonly used; a score of ≥9 often indicates readiness for discharge.

Discharge Criteria: Scoring & Send-off - The Go/No‑Go

• Scoring for Readiness:
  • Modified Aldrete Score: Assesses recovery post-anesthesia.
    • 📌 ALDRETE: Activity, Respiration, Circulation, Consciousness, O2 Saturation.
    • Threshold for PACU Phase II transfer/readiness: Score ≥9 (out of 10).
  • PADSS (Post Anesthetic Discharge Scoring System): Key for home discharge.
    • Evaluates: Vital signs, Activity (ambulation), Nausea/Vomiting, Pain, Surgical Bleeding.
    • Home readiness: Score ≥9 (out of 10).
• Final Checks (Go/No-Go):
  • Responsible adult escort confirmed.
  • Written & verbal discharge instructions given (incl. emergency contact info).
  • Pain controlled with oral analgesia.
  • Minimal nausea & vomiting.

⭐ Patient must be able to tolerate oral fluids and void (if applicable, e.g., post-spinal or urologic surgery) before discharge, in addition to achieving target PADSS score.

High‑Yield Points - ⚡ Biggest Takeaways

• PADSS (Post Anesthetic Discharge Scoring System) is a key discharge assessment tool.
• Stable vital signs (near baseline) are mandatory.
• Patient must be alert, oriented, or at preoperative mental status.
• Pain and PONV (Postoperative Nausea and Vomiting) must be controlled.
• Ability to ambulate (if appropriate) and tolerate oral fluids is crucial.
• A responsible adult escort and clear discharge instructions are essential.
• Voiding may be required post-spinal or urological procedures.