On discharge

Discharging with appropriate home support

All day surgery patients should have a clear discharge plan prior to admission to ensure they are supported through the post-operative phase of care.

This should include:

• pre-arranged transport home
• a designated carer capable of monitoring recovery and providing care
• any additional equipment or supports arranged prior to admission
• staff, carer and patient information on what post-operative complications to look out for, and how to escalate concerns
• a documented clear and structured escalation plan for patients and other health providers that meets local protocols and pathways
• appropriate discharge location and environment, including staying within 30 minutes from their nearest health service. Medihotels provide an option for those who do not have appropriate accommodation options close to a health service
• appropriately selected follow-up plan that meets patient, surgeon and resourcing needs, with contact within 24 hours of discharge. These may include virtual care, Hospital in the Home services, a pre-arranged GP appointment prior to admission, or outpatient services.

Post-surgery care instructions

It is important to communicate post-operative care instructions clearly and effectively, including the criteria for escalating any concerns.

• Clear written and verbal post-operative instructions should be provided to patients or their carer in consideration of health literacy. This includes instructions on pain management, a follow-up care plan, and clear escalation criteria.
• A phone number should be provided to the patient, carer and GP so any questions, concerns, or need for emergency advice can be addressed in a timely manner. Closed loop communication should facilitate communication back to the person escalating the concern.
• Accessibility of written and verbal information should be considered relative to the needs of the patient and/or carer in the pre-operative phase. This ensures provision of discharge support that is timely and appropriate for people who are culturally and linguistically diverse or who have higher accessibility needs in line with clinical care standards.

24-48 hour follow-up care

For safe, effective day surgery models, appropriate monitoring is required post discharge. All day surgery patients should be contacted from 24 to 48 hours post discharge.

The chosen option for follow-up will depend on local service resources/pathways, type of surgery, patient/surgeon preference and patient factors, such as age and risk.

Discharge pathways that can ensure timely follow-up within 24 hours of leaving hospital may include:

• A virtual model of care – Follow up with a phone call, text message, video call, or message through a remote patient monitoring (RPM) platform.
• Pre-arranged GP or outpatient appointment – Clearly communicate with the patient’s GP to inform them of day surgery, pre-arrange an appointment, and provide them with clear information on expectations for the primary care practitioner.
• Hospital in the Home (HITH) or Better at Home services – These services provide post-operative care in the home that would otherwise need to be delivered within a hospital as an admitted patient. HITH may also be utilised on occasions when patients require admitted care in preparation for planned surgery. Note that the patient is not eligible for GP care while at home under the HITH bed card.