drive themselves home after the procedure or surgery, particularly if they received sedation or anesthesia.6,10,20-26
Purpose
This resource provides policy considerations for outpatient or same-day surgical settings regarding discharge planning specific to patient transportation. Alternative policy considerations for various situations are presented, as each facility will establish policies that best serve its patients.
Policy Considerations: Regulatory and Accreditation Requirements
Concern exists for patients undergoing sedation or anesthesia who do not have a caregiver to aid them in their transport home after a procedure.6,10,27 Healthcare facilities should consider both patient safety and potential legal liabilities when developing policies for post-procedure transportation. A comprehensive admission and discharge policy, developed by the interprofessional team, that addresses transportation and care at home can prevent case cancellation or a significant challenge on the day of the procedure. The policy is valuable to assist the team and patient in decision making that supports all parties involved. It also addresses patient safety considerations unique to the community served and the services provided, as well as options that balance the facility’s responsibility to the patient and the patient’s wishes. Engaging an interprofessional team in planning, policy development, and ongoing education helps foster maximum acceptance and consistent communication of the policy to patients.10
To optimize post-procedure patient safety and comply with applicable law, regulations, and accreditation standards regarding patient transport after discharge from an outpatient or sameday surgical setting:
Verify federal, state, and local law and regulations as well as facility accreditation requirements
Engage the facility’s legal counsel, risk manager and/or similar role to review and address liability and legal concerns related to patient discharge and transportation.
Hospitals28
CMS Survey Protocol, Regulations and Interpretive Guidelines for Hospitals
§482.43 Condition of Participation: Discharge Planning
“The hospital must have in effect a discharge planning process that applies to all patients. The hospital’s policies and procedures must be specified in writing.”
Interpretive Guidelines §482.43
“Hospital discharge planning is a process that involves determining the appropriate posthospital discharge destination for a patient; identifying what the patient requires for a smooth and safe transition from the hospital to his/her discharge destination; and beginning the process of meeting the patient’s identified post-discharge needs.”
Ambulatory Surgical Centers29
Centers for Medicare and Medicaid Services (CMS) Condition for Coverage
§416.52(c) Standard: Discharge.
“The ASC must -
(3) Ensure all patients are discharged in the company of a responsible adult, except those patients exempted by the attending physician.”
Facility accreditors (e.g., The Joint Commission, Accreditation Association for Ambulatory Health Care [AAAHC], QUAD A) incorporate similar language in their facility discharge requirements.
If the facility provides or arranges transportation services, the policy should address compliance with relevant laws and regulations for safe transport, as addressed in some accreditation standards.
Policy Considerations: Discharge after Sedation or Anesthesia with a Responsible Individual
Instruct patients in advance of the procedure to make arrangements for a responsible individual to accompany them to the healthcare facility, drive them home or accompany them in a ride-share service, taxi, or public transportation, and be present or readily available to assist them at home.5,18,30
o Instructions may be provided in the surgeon’s or proceduralist’s office at the time the case is scheduled.
o Verify availability of a responsible individual during discussions or health history acquisition prior to the patient’s arrival at the facility.
o Discharge planning instructions should also be provided to the responsible individual who will be accompanying the patient home.
o If the responsible individual accompanying the patient home is not the same as the responsible individual/caregiver who will remain with the patient, the facility should contact the responsible individual/caregiver to review the discharge instructions and to answer any questions.18
Determine whether the patient’s responsible individual is present to pick up the patient or if they are considered a “no show” for various reasons.31
Determine whether a responsible individual is available to accompany the patient home.
Determine whether a responsible individual is available to remain with or be readily available to the patient for 12-24 hours.18
If not, what are your facility’s requirements for discharge and transport home?
Advise the patient and responsible individual that patients should not drive after sedation or anesthesia as mental alertness, coordination, and physical dexterity may be impaired.5
Policy Considerations: Determining if a Patient is a Candidate for Unaccompanied Discharge after Sedation or Anesthesia
The following policy considerations are presented to address the scenario where the patient does not have a responsible individual to transport or accompany them home. Figure 1 summarizes policy considerations, with more detail presented below.
requirements, including discussion of the anesthetic and procedural risks related to being discharged without an accompanying responsible individual.
o A copy of the completed, signed informed consent form should be given to the patient and added to the patient’s healthcare record.
A patient may choose to leave against medical advice (AMA) after the surgery or procedure.
o Consult with the facility’s legal counsel, risk manager and/or similar role regarding AMA policies to guide policy development.18
o If a patient insists on driving home, the patient is technically not being discharged, but is leaving against medical advice.5,33
o Document the patient discussion of the rationale for the required care and the patient’s understanding of the risks to self and others associated with driving home and non-compliance.5,33
o While a facility has a responsibility to ensure that a patient is discharged appropriately, the facility does not have control of the patient’s actions once the patient leaves.5,30
Discharge Considerations
Patients recovering from surgery or a procedure may not be placed in a waiting room or area unless they have been discharged and are waiting briefly while the responsible individual who accompanied them brings a car to the entrance.29
The facility may determine additional discharge evaluation criteria, beyond the general post-anesthesia discharge criteria, for the patient who may be discharged without a responsible individual.
o The facility policy may require a specific period of time after discharge criteria are met that the patient must remain in the facility.
o Anesthesia professionals should work closely with the post-anesthesia care unit (PACU) or recovery room staff to evaluate the patient.
o Verify that the patient has stable vital signs and can complete tasks such as sitting up, dressing, and ambulating prior to discharge.
Discharge Instructions
o Confirm and document that the patient and responsible individual, if available, understand the discharge instructions.
o Maintain a copy of the provided document in the patient’s chart.
o Provide the patient both verbal and detailed, written, understandable discharge instructions.
o Discharge instructions may include, but are not limited to, the following:
▪ Medications
• Specify the name, purpose, dosage, frequency, and route for each medication that is new and/or continued. Address medications that should be delayed or discontinued. Address when the patient can resume any pre-operative medications.
• Discuss the pain management plan and any side effects of the pain management treatment with the patient and answer their questions.
• Emphasize the importance of adherence to labeling directions.34
• Discuss the safe use, disposal, and storage of opioids, if prescribed.
▪ Activity
• Instruct the patient not to drive, operate machinery or power tools, consume alcohol, make important personal or business decisions, or sign important document for the next 12-24 hours.34
• Encourage the patient to mobilize as able the day of the procedure according to the surgeon’s or proceduralist’s recommendations.
• Emphasize that hydration and nutrition are important to minimize dizziness or drowsiness to promote healing.34
• Discuss activities that may exacerbate or reduce pain and strategies to address pain management at home.
▪ Post-Discharge Safety Monitoring
• Provide follow-up care instructions with information on necessary supplies and treatment procedures required at home (e.g., dressing changes).
Instruct the patient and caregiver regarding the signs and symptoms that could indicate post-procedure complications.
• Provide appropriate names and phone numbers for routine followup and emergency care (e.g., surgeon’s or proceduralist’s office vs 911, emergency department).
References
1. Taylor D. Planning for Surgery’s Future: Ambulatory Surgery Centers Expected to Skyrocket. OR Management News. Updated Jan 1, 2024. Accessed Feb 28, 2025, https://www.ormanagement.net/Opinion/Article/12-23/Planning-for-Surgerys-FutureAmbulatory-Surgery-Centers-Expected-to-Skyrocket/72398
2. Surgical Procedures Continue to Shift to Outpatient. Outpatient Surgery. Updated Jun 6, 2024. Accessed Feb 28, 2025, https://www.aorn.org/outpatient-surgery/article/surgicalprocedures-continue-to-shift-to-outpatient
3. ASCs: A Positive Trend in Health Care. Ambulatory Surgery Center Association. Accessed Feb 28, 2025, https://www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositive trendinhealthcare
4. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health Oct 2013;38(5):976-93. doi:10.1007/s10900-013-9681-1
5. Should Patients be Accompanied When Discharged from Ambulatory Surgery? PA PSRS Patient Saf Advis 2007 Sep;4(3):100-3.
6. Ip HY, Chung F. Escort accompanying discharge after ambulatory surgery: a necessity or a luxury? Curr Opin Anaesthesiol. Dec 2009;22(6):748-54. doi:10.1097/ACO.0b013e328331d498
7. Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health. Apr 2012;14(2):350-5. doi:10.1007/s10903-010-9410-0
8. Yang S, Zarr RL, Kass-Hout TA, Kourosh A, Kelly NR. Transportation barriers to accessing health care for urban children. J Health Care Poor Underserved. Nov 2006;17(4):928-43. doi:10.1353/hpu.2006.0137
9. Wolfe MK, McDonald NC, Holmes GM. Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997-2017. Am J Public Health. Jun 2020;110(6):815-822. doi:10.2105/ajph.2020.305579