Care Opinion

Text size

Theme

Language

Videos in BSL or ISL
Help with language translation
Help with reading or listening

I do not think that I was fit for discharge

Posted By BigAggy64

"I do not think that I was fit for discharge"

About: Borders General Hospital / Day Procedure Unit

(as a service user),

I recently came to ward 17 of the BGH for a Cholecystectomy and I would like to share my thoughts/opinions on this being a day procedure.

As both an NHS employee and a patient on more than one very long list, I understand the need for a quick turnaround to free up beds for the ever expanding waiting lists. And I must start by saying that my nurse  was absolutely lovely - my thoughts/comments are in no way aimed at their appropriate and friendly care.

However, I am concerned that discharge from these cases could too easily become a tick box procedure, (have you eaten ✔️ have you peed ✔️ have you been given the discharge info ✔️ etc). For me, there didn't seem to be the person centred care that I was trained to observe. Yes, I peed - but it took a full 10 minutes of concentration and straining to achieve this - is that a ✔️. Yes I was given the discharge info - but I was still out of it under the influence of the GA - is that a ✔️. Yes I ate some toast but I forced myself to because it was expected and it made me feel utterly nauseous. Is it normal that a patient who had a 9am op should still be unable to sit up/stay awake by 5pm? And then be discharged by 7pm?

Personally, I do not feel that: I was making appropriate decisions when I was discharged. I do not feel that: I was eating/peeing properly until a full 24hrs later, so approx 5pm the following day. I do not feel that: I had sufficient pain management for the 1st 48hrs post op. Additionally, I was so unsure about the post op care instructions that I was given whilst still out of it that I was asking medical friends for advice 4-5 days later.

Now, I expect there are many people who have managed this procedure as a day patient. But I do wonder how many patients, like me, left on the day because that was what was expected of them, only to wonder for many days afterwards how they were discharged too soon. I do not think that I was fit for discharge until the following evening. I believe that this was probably due to the fact that I had been unwell for several months (due to the gallbladder) and was not at my strongest. But surely this is exactly what person centred care is all about?

My hope is that, my making the effort to comment here, will help inform future decisions about discharge of day procedure patients.

More about:
Do you have a similar story to tell? Tell your story & make a difference ››

Responses

Response from Brian Rintoul, Charge Nurse, Planned Care, Ward 17, Borders General Hospital, NHS Borders 15 months ago
Brian Rintoul
Charge Nurse, Planned Care, Ward 17, Borders General Hospital,
NHS Borders

Charge Nurse

Submitted on 02/05/2024 at 19:19
Published on Care Opinion on 03/05/2024 at 09:37

Thank you for taking the time to post a response on your recent experience on ward 17 at the Borders General Hospital. I appreciate you bringing your concerns to our attention. Our aim is to provide person centred care to all patients on our unit and your feedback allows us to monitor our performance, alerts us to patients concerns and enables us to evaluate the care we provide.

Day surgery at the Borders General is not provided to "free up beds" but rather is a stand alone service which for most patients allows quicker recovery, less disruption to home and family life and a reduction in the risk of hospital acquired infection. It also allows us to significantly increase the amount of procedures we can provide to the Borders population than would be possible if an in-patient bed was required for each patient and is a much more efficient use of NHS resources. It is now viewed as the default position for most surgical procedures and for all ages of patients.

The care we provide is modelled on guidelines produced by The British Association of Day Surgery, The Royal College of Surgeons, The Royal College of Anaesthetists, The Association of Anaesthetist and Royal College of Nursing. The procedures carried out daily on the unit are recognised by these organisations as appropriate day surgery procedures to be promoted in all cases.

Patients considered for day surgery must meet set criteria to be deemed "fit to proceed" for surgery and must agree to be treated as a day case. If not then an in-patient bed can be arranged for the procedure although this can lead to cancellation as there is huge demand and pressure on in-patient beds.

Anaesthetic drugs used in surgery may remain in the patients system for 24-48 hours and can affect memory, concentration and reflexes. For this reason the patient must have a responsible adult with them for the first 24 hours after surgery, are advised they should not to drive and should also avoid signing legal documents for 48 hours.

Pain control is often an issue after surgery and is the main concern of most patients. However it is impossible to carry out any surgical procedure without causing pain. We try our best to manage this with appropriate analgesia but unfortunately some degree of discomfort must be expected. Our patients are discharged with a combination of analgesics which it is hoped will allow them to manage their pain at home to satisfactory levels in the immediate post-op period and beyond.

Post-op nausea and vomiting is another common side effect of anaesthetic drugs which we do our best to control with appropriate medication although in a small number of cases this may not be successful.

Ideally we expect each patient to manage some diet and be able to pass urine before discharge. This does not have to be huge volumes and indeed in some day surgery units it is not considered a requirement for discharge.

None of the above symptoms would be viewed as a reason not to discharge a patient as it is a transient situation which will gradually improve as the anaesthetic wears off and the initial effects of surgery improve.

Although day surgery is now accepted as the norm in most cases, we recognise that not all patients will meet our discharge criteria, this is the reason patients are asked the questions you mention in your response. These are discharge criteria rather than a "checklist" and should be used as part of a nursing assessment of fitness for discharge. However the most important part of the assessment to be considered is how the patient feels. If the patient does not feel ready for discharge then an in-patient bed should be arranged. I would have hoped that had you expressed your concerns to the nursing staff at the time this would have been arranged for you.

I am sorry you had such a negative experience on our unit but am also gratified to read your comment about the "absolutely lovely" nurse who looked after you. If you would like to discuss any aspect of your care or concerns regarding your treatment I would be happy to speak with you. Wishing you a continued recovery to good health.

Kind regards, Brian Rintoul. Charge Nurse, Ward 17, Borders General Hospital

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by BigAggy64 (a service user)

Thank you for your reply. I understand all that you have pointed out. However, if the patient is asked these questions whilst still heavily under the influence of anaesthetic, they are not able to make sound decisions, or indeed request a longer stay. For whatever reason, I believe I was still so 'out of it' at the allotted time for being asked the "assessment questions", that I barely registered the questions (hence me calling it tick box), let alone be able to make any cognitive decisions. Therefore, my comments re patient centred care applies to ensuring that the patient is able to respond to this assessment appropriately.

I would also like to reiterate that, other than this, my experience on the unit was superb!!

Best wishes

Opinions
Next Response j
Previous Response k