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Recovery Process

First Stage Recovery

This constitutes the initial recovery period following anaesthesia, it starts from handover of the patient to the care of the recovery nurse until the patient is discharged to the ward. In ambulatory surgery the aim should be to ensure that the patient awakes pain free, without nausea and is quickly orientated. This will minimize the amount of time the patient needs to stay in the Recovery Room.
Even in the best hands patients will develop problems in the Recovery Room and it is important that the nursing staff have protocols agreed by the anaesthetic department that they can follow for the management of post operative nausea, vomiting and pain. The aim should be to control these as quickly as possible so as to ensure the smooth transition back to the ward area for second stage recovery. It is important to note that the facilities required for the Recovery Room will be similar to those for inpatient surgery. Discharge criteria will also be similar.

Second Stage Recovery

This is an important phase of the ambulatory surgery process and the management and education of both the patient and their carer during second stage recovery is crucial to our success. It is this stage more than any other that can mean the difference between providing a quality service or what is merely seen as being part of a ‘production line’ or ‘conveyer belt’. Furthermore, success at this stage can make a large difference to the admission rate from your day unit. With this in mind, it is essential that patients are given time to recover and do not feel pressurised into leaving too early. However, it is also important that the staff have a routine for the mobilisation of patients. This routine will not only need to be different for the various specialties and operations, but also sometimes between surgeons in the same specialty and for different patients.
Environment

The use of beds is not recommended in ambulatory surgery, as they reinforce the ‘patient role’ in the minds of our patients, their carers and even the medical and nursing staff.
The use of trolleys immediately introduces to everyone the concept that this is a short visit to hospital. Suitable trolleys help by:
  • reducing manual moving of patients (reducing dangers to both patient and staff in an area of fast throughput) and
  • assisting the postoperative mobilisation of the patient
Every day unit needs to evaluate the trolleys available on the market and find those that suit their patient population and the type of surgery performed. Ideally the trolley should:
  • have a reasonably thick comfortable mattress (as the patient may spend several hours on it)
  • have a good range of height adjustment (a trolley that obviates the need for steps to get on and off will be inherently safer)
  • meet all surgical requirements (width, height adjustment, attachments)
  • meet all anaesthetic requirements (ease of tipping head down, easy to push!)
  • meet safety requirements (suitable sides to prevent patient falling, able to deal with the maximum weight of patient allowed on the day unit, adaptable for paediatric use)
It is therefore obvious that anaesthetic considerations form only one part of the design of a successful ambulatory surgery trolley. Careful selection can yield benefits to all users but, unfortunately, there may also be a need for some degree of compromise.
The day unit should also have sufficient numbers of reclining chairs to allow graduation of patients into the semi-recumbent position, as this can help as part of this continual process of getting patients ready for discharge. The ward area used should also have:
  • sufficient staffing to allow patient monitoring and education
  • a quiet restful atmosphere
  • privacy
  • ample bathroom/toilet facilities
  • facilities to provide fluids and food

Hints and tips

The choice of suitable food and fluids in the recovery process can make a large difference to your success rate and the quality of service perceived by your patients. Many of you who have worked on delivery wards in maternity units will be aware of the effect of the smell of toast on your taste buds. It does appear to work in ambulatory surgery patients, and is worth considering. Patients often have a dry mouth after anaesthesia and sandwiches can be difficult to eat – it does appear that buttered toast is much easier for patients to swallow.
A further tip that can be useful is the use of distraction therapy in children following their surgery. The provision of a video/television and a supply of a suitable choice of children’s films and cartoons returns many screaming children (who may feel confused, sick or be in pain) into quiet docile human beings.