INSTRUCTIONS FOR AMBULATORY SURGERY - PATIENT COMPREHENSION AND COMPLIANCE

Ambulatory surgery has proliferated as a result of increasing inpatien t costs(1). Its high level of safety has resulted in its extension to less healthy, often elderly patients(2), Patient compliance with instr uctions is essential to avoid morbidity. We aimed to identify subgroup s potentially at risk due to non-compliance. A confidential questionna ire was administered to 220 consecutive daycase patients. Data include d: patient demographics, duration of fasting, taking of medications th at morning, importance of fasting and medication instructions, mode of post-discharge transport, and whether they had someone to stay with t hem that night. Seven (3.5 per cent) patients admitted to non-complian ce with fasting instructions, with 8 per cent considering these instru ctions non-essential. Thirteen of 59 patients on medications took them against instructions, with 9 patients considering the instructions no n-essential. Eight patients admitted intending to drive home; 7 per ce nt admitted to having no one to stay with them on the night of surgery . A significant minority of patients (particularly male) admit to non- compliance with ambulatory surgery instructions; these figures may be underestimates. Absence of anaesthetic/medical input and lack of reinf orcement probably contribute to non-compliance, Some medication-relate d noncompliance may be appropriate: (e.g. antianginals, antihypertensi ves) .and may reflect conflicting instructions given to the patient: T he stopping of all medications prior to ambulatory surgery needs revis ion. Older patients living alone may not be suitable candidates for am bulatory anaesthesia.