FACTORS AFFECTING DISCHARGE TIME IN ADULT OUTPATIENTS

Discharge time (total recovery time) is one determinant of the overall cost of outpatient surgery. We performed this study to determine what factors affect discharge time. Details regarding patients, anesthesia , surgery, and recovery were recorded prospectively for 1088 adult pat ients undergoing ambulatory surgery over an 8-mo period. The contribut ion of factors to variability in the discharge time was assessed by us ing multivariate linear regression analysis. In the last 4 mo of the s tudy, nurses indicated the causes of discharge delays greater than or equal to 50 min in Phase 1 or greater than or equal to 70 min in Phase 2 recovery. When all anesthetic techniques were included, anesthetic technique was the most important determinant of discharge time (R-2 = 0.10-0.15; P = 0.001), followed by the Phase 2 nurse. After general an esthesia, the Phase 2 nurse was the most important factor (R-2 = 0.13; P = 0.01-0.001). In women, the choice of general anesthetic drugs was significant (R-2 = 0.04; P = 0.002). The three most common medical ca uses of delay were pain, drowsiness, and nausea/vomiting. System facto rs were the foremost cause of Phase 2 delays (41%), with lack of immed iate availability of an escort accounting for 53% of system-related de lays. We conclude that efforts to shorten discharge time would best be directed at improving nursing efficiency; ensuring availability of an escort for the patient; and preventing postoperative pain, drowsiness , and emetic symptoms. The selection of anesthetic technique and anest hetic drug seems to be of selective importance in determining discharg e time depending on patient gender and type of surgery. Implications: The relative importance of anesthetic and nonanesthetic factors were e valuated as determinants of discharge time after ambulatory surgery. P ostoperative nursing care was the single most important factor after g eneral anesthesia; anesthetic drugs, anesthetic technique, and prevent ion of pain and emetic symptoms were of selective importance depending on patient gender and type of surgery.