3322 A discharge scoring system allows early discharge from the ambulatory endoscopy center.

Abstract

Background: Approximately 40% of endoscopy costs are related to sedation, monitoring, and recovery. Anesthesiologists have developed scoring systems to determine when patients (pts) can be safely released after outpatient surgery. Criteria specific to endoscopic practice are lacking, and many endoscopy centers arbitrarily hold pts in recovery 30 minutes (min) before discharge (D/C). Aims: To develop criteria for determining homereadiness after sedated endoscopic procedures. To determine predictors that allow “fast-tracking” of pts for early D/C home. Methods: We developed a new discharge scoring system (DSS) by modifying the postanesthesia discharge score (PADS) for endoscopic practice (see table). The DSS evaluates 5 parameters of recovery (each scored 0-2, max 10/10). DSS scores of 9/10 or 10/10 are considered compatible with safe D/C. An investigator followed colonoscopy outpatients into the recovery room (RR) and obtained DSS scores every 15 min until D/C. Per protocol, endoscopy nurses followed pts in recovery for 30 min before independently assessing their readiness for D/C. All pts had received sedation with IV meperidine/midazolam (mean dose 73.9/2.9 mgs). Results: 100 pts were studied (M/F 49/51, mean age 48.8 yrs). 77/100 pts fulfilled D/C criteria at 15 min (DSS > 9). Further observation of these 77 pts to 30 min revealed no deterioration in DSS score or problems precluding safe D/C. In fact, all patients with a 15- min DSS > 9 were subsequently released at 30 min by the RR nurse (blinded to DSS score). Univariate analysis found supplemental O2requirement (due to sustained desaturation during colonoscopy) the clinical variable most closely linked to DSS score. Pts not requiring O2had an 87% (61/70) chance of meeting D/C criteria (DSS > 9) at 15 min compared to only 46% (14/30) of pts requiring O2(p < 0.001). Conclusions: An endoscopy-specific discharge scoring system accurately predicts readiness for home D/C. Pts not requiring O2should be fast-tracked for D/C assessment within 15 min. Utilization of standardized D/C criteria could improve efficiency and lower costs of post-endoscopic monitoring. Background: Approximately 40% of endoscopy costs are related to sedation, monitoring, and recovery. Anesthesiologists have developed scoring systems to determine when patients (pts) can be safely released after outpatient surgery. Criteria specific to endoscopic practice are lacking, and many endoscopy centers arbitrarily hold pts in recovery 30 minutes (min) before discharge (D/C). Aims: To develop criteria for determining homereadiness after sedated endoscopic procedures. To determine predictors that allow “fast-tracking” of pts for early D/C home. Methods: We developed a new discharge scoring system (DSS) by modifying the postanesthesia discharge score (PADS) for endoscopic practice (see table). The DSS evaluates 5 parameters of recovery (each scored 0-2, max 10/10). DSS scores of 9/10 or 10/10 are considered compatible with safe D/C. An investigator followed colonoscopy outpatients into the recovery room (RR) and obtained DSS scores every 15 min until D/C. Per protocol, endoscopy nurses followed pts in recovery for 30 min before independently assessing their readiness for D/C. All pts had received sedation with IV meperidine/midazolam (mean dose 73.9/2.9 mgs). Results: 100 pts were studied (M/F 49/51, mean age 48.8 yrs). 77/100 pts fulfilled D/C criteria at 15 min (DSS > 9). Further observation of these 77 pts to 30 min revealed no deterioration in DSS score or problems precluding safe D/C. In fact, all patients with a 15- min DSS > 9 were subsequently released at 30 min by the RR nurse (blinded to DSS score). Univariate analysis found supplemental O2requirement (due to sustained desaturation during colonoscopy) the clinical variable most closely linked to DSS score. Pts not requiring O2had an 87% (61/70) chance of meeting D/C criteria (DSS > 9) at 15 min compared to only 46% (14/30) of pts requiring O2(p < 0.001). Conclusions: An endoscopy-specific discharge scoring system accurately predicts readiness for home D/C. Pts not requiring O2should be fast-tracked for D/C assessment within 15 min. Utilization of standardized D/C criteria could improve efficiency and lower costs of post-endoscopic monitoring.