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  • FIRST POST
    • anonanmoo
    • By anonanmoo 19th Sep 16, 6:30 PM
    • 8Posts
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    anonanmoo
    day surgery without 24h care
    • #1
    • 19th Sep 16, 6:30 PM
    day surgery without 24h care 19th Sep 16 at 6:30 PM
    I'm on the wating list for minor surgery. It would usually be done as a day case but I have no one to look after me for 24 hours afterwards so I'm told I'll need to spend the night in hospital. I understand why they say this, but I really don't think I can cope (I'm high functioning autistic). I've had the procedure before so I know what to expect afterwards (was in a relationship then so had 24h care) and am happy to take the minutely small risk of being home alone afterwards. I've asked the hospital and PALS and all I can get out of them is "discuss this at your pre-op assessment" - so wondering if anyone has been in a similar situation and managed to avoid a night in hospital?
Page 2
    • anonanmoo
    • By anonanmoo 20th Sep 16, 8:52 AM
    • 8 Posts
    • 0 Thanks
    anonanmoo
    thanks everyone - you've all made me feel a bit more confident about telling them what's what at my pre-op!
    • mumps
    • By mumps 20th Sep 16, 10:22 AM
    • 4,931 Posts
    • 10,339 Thanks
    mumps
    I wonder what they would do if someone just said, "I'm off." If you have capacity can they detain you? Even if its not a good decision you are entitled to make that decision. I assume you would have to sign some sort of disclaimer.

    I nearly discharged myself once. Doctor had told me I could go. I got myself sorted out, packed my bag, got dressed etc. Nurse then said I couldn't go as doctor had left and hadn't signed the discharge form. I said I was going as I had been told by my doctor that I could. She got a bit flustered and found another doctor who signed the form. She didn't want me to go but it didn't seem like she was going to be able to stop me.

    Sorry, I think I'm a bit of a rebel. I'm sure people are probably better following medical advice.
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    • fuzzyduck22
    • By fuzzyduck22 20th Sep 16, 1:50 PM
    • 197 Posts
    • 451 Thanks
    fuzzyduck22
    At the end of the day they can't keep you in but please stay in until you are fully awake/recovered and had something to eat and drink.

    I had a minor procedure last year and had no-one staying with me, told them I was making my own way home and I had family at home! Just no driving, if you have an anaesthetic you can't drive for 24 hours.

    Hope all goes well x
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    • Dill
    • By Dill 20th Sep 16, 8:00 PM
    • 1,570 Posts
    • 2,844 Thanks
    Dill
    hmm... they ask for details of the person who's going to be collecting you, and I'm not sure what they'd do when that fictional person failed to show up!
    Originally posted by anonanmoo
    They will let you get a taxi home. Not everyone has someone available to drive them home, and obviously you're not supposed to get on a bus or walk home after a GA, but getting in a taxi should be fine.
    • Owain Moneysaver
    • By Owain Moneysaver 20th Sep 16, 9:56 PM
    • 6,768 Posts
    • 6,919 Thanks
    Owain Moneysaver
    Would staying in a hotel be less stressful than overnighting in hospital?

    You wouldn't be on your own, but you'd have more privacy.
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    • MonkeyDr
    • By MonkeyDr 20th Sep 16, 10:55 PM
    • 20 Posts
    • 16 Thanks
    MonkeyDr
    Hi

    I am a hospital Dr and do some daycase procedures. I thought that my take your situation might be useful.

    So long as you have capacity (roughly = retain and understand salient information, weigh it in the balance and communicate your decision) you can self-discharge against medical advice whenever you want. As can anyone else. Anyone self-discharging is likely to be asked to sign a form to show that they have been told the risks.

    You are assumed to have capacity as the default position, and your decision doesn't have to be one that the dr agrees with. Note that some anaesthetic agents / sedatives / pain meds can make you woozy enough to temporarily lack capacity, so this may well have to be assessed at the time you want to go rather than earlier on in the day before the procedure.

    Out of hours (after approx 5) coming to see someone who wants to self-discharge will be a low priority thing for the on-call dr and you may have to wait a while. You would do best to go through it with a member of your team so do speak up earlier in the day if you can. That is also better as your team will know the specific risks for you and your procedure.

    Your plan to bring it up at the pre-op assessment is perfect. If it is an absolute red-line for you that you will not stay in then you need to say so. It may affect the risk / benefit balance such that you don't have the procedure at all; I do some day-case procedures where the risk of serious complication is high if the patient does strenuous activity within 10-14 days, and I have cancelled a few if the patient absolutely cannot promise me that (eg if they work as a builder and can't afford time off work). No point wasting your time / taking a slot someone else could have had to find it cancelled on the day.

    I hope that helps, and I wish you luck. I hope you will find the medical team supportive and keen to be flexible as much as they can while still being safe.

    MD
    • pollypenny
    • By pollypenny 21st Sep 16, 9:03 AM
    • 20,026 Posts
    • 50,880 Thanks
    pollypenny
    OP, the 24 hours of done one keeping an eye on you is for a reason.

    DS had yet another knee operation in the summer, to remove a screw left behind from a previous dismantling of an ACL repair. It went well. DIL picked up him at 5pm.

    She went off to work the next day, having to stay away overnight. We were there, up and down stairs with tea, toast and ice packs. All well until midday.

    I heard him struggling down stairs on the crutches. He was in agony. The anaesthetic block had completed worn off and the pain killers didn't touch it.

    We took him to the hospital on a terrible drive where he was rolling in agony and where he was seen immediately. He was given a cortisone injection, much stronger painkillers and told to dispense with the bandages, as the ice was not reaching the effected area.

    None of this was expected. There are good reasons why people need a safety net after day case procedures.
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    • Crimson60
    • By Crimson60 21st Sep 16, 9:14 AM
    • 504 Posts
    • 123 Thanks
    Crimson60
    Although I am not recommending this, a friend of mine was very upset the morning after a hysterectomy when a doctor was rude to her. She said nothing, dressed herself quietly, left a note by her bed and simply walked out - all in silence! She took a taxi home and at that time she lived alone. They could do nothing about it. She signed nothing.

    Days later a district nurse turned up unannounced and took her stitches out.

    Not recommended but she said she was less stressed at home alone.

    Crimson
    • EpsomOldie
    • By EpsomOldie 21st Sep 16, 11:31 AM
    • 169 Posts
    • 453 Thanks
    EpsomOldie
    Hi OP, not sure if you've said whether it's a general or local anaesthetic, but my experience follows which you might find helpful.

    I had minor surgery for removal of a growth on my foot in a day hospital. It was a local anaesthetic and I'm considered to be low risk: no history of complications, don't smoke, not diabetic, no high blood pressure, heart and lungs fine etc.

    At the pre-op, when I said I lived alone, I was asked if a friend could stay with me overnight and I said yes. Afterwards, I thought, I could ask a friend to come and stay overnight, but I'd have hated it and I decided it wasn't necessary. I ran it past my friend and we agreed that I'd see how I felt after the op and if I felt worse than I anticipated, she'd come and stay over.

    I made my own way to the hospital on the day, mentioned to the staff that the 'friend looking after me didn't drive so a taxi would be collecting me', had the op, and then once I'd been shown how to use the crutch, summoned a taxi and went home. I felt fine though it was very weird having a completely numb foot and even weirder when it started to thaw out.

    I don't think I'd have done the same if it had been a general anaesthetic.

    Hope all goes well for you on the day.
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    • Sncjw
    • By Sncjw 21st Sep 16, 7:56 PM
    • 1,056 Posts
    • 645 Thanks
    Sncjw
    The reason they ask for someone to look after you is in case of any reaction from the drugs given to you. If you have the op and they find no one picking you up with they will admit you . It's best to go to the pre assessment and mention your concerns with your autism and staying in hospital.
    • MonkeyDr
    • By MonkeyDr 21st Sep 16, 10:58 PM
    • 20 Posts
    • 16 Thanks
    MonkeyDr
    As a response to one of the posts above: please do not just walk out of hospital without discussing it with a Dr / nurse. (I appreciate that the OP has not suggested that he / she would).

    Hospitals have a duty of care to their patients. If someone leaves the hospital staff need to be sure that the patient is safe to leave or fully understands the potential consequences. No-one can keep you there against your will (assuming you have capacity), but if you disappear without specific risks being explained to you the staff may think it necessary to track you down to check on your safety. I have been involved in cases where people have wandered off but they have had life-threatening potential issues and we have had to get out-of-hours GPs or even the police out to find them and check they are ok.

    Every now and again people do have funny reactions to medication such that they aren't thinking straight - imagine the uproar if one of those patients came to harm after disappearing from the ward and medics denying all responsibility.

    Tl,dr: you are free to leave when you want, but doing so without discussion with medical team can waste time and resources and so affect other patients
    • Poppy9
    • By Poppy9 21st Sep 16, 11:21 PM
    • 17,962 Posts
    • 22,249 Thanks
    Poppy9
    I had surgery last year and I was discharged with little care.

    I went down for surgery at 3pm and was back on the ward just after 5pm. I had a GA and I was told in the morning that I had to stay 5 hours after being back on the ward before being discharged.

    A little after 6pm I was told I could go home as I had been up to the toilet, drunk a cup of tea and eaten a sandwich. OH had gone home to get DD so I was sitting alone when I was told I could go home.

    Then there was a change of shift and a much more brusque ward sister - who said she was too busy to discharge us (there were 2 of us to go home) then said "ok you can go, the nurse attached to your surgeon's clinc will be in touch tomorrow for follow up care and keep your dressing dry". By 8pm I am home. 5pm the following day the nurse rang to ask if I was okay. I was fine so she asked to see me 2 days later.

    I found the second day after surgery I was knackered and at my follow up appointment the nurse was not impressed to see I still had the pressure dressing in place. Apparently I should have been told to remove it 24 hours later so it was well stuck to me!!!

    The whole stress of the operation and the GA wore me out for over a week and I was very surprised to be told I could go home an hour after coming back from theatre. They did probably ask if I had someone at home but they certainly didn't check I was escorted by this person off the ward.

    I would mention at your pre op assessment if you will be alone. I know you might hate the thought of staying overnight in hospital but if you are late going down for your day surgery you might be too tired to care. I thought I might have to stay as they had said 3pm was cut off for home that day. If I had stayed there would only have been me and one other women in the ward. As it was the other woman was there on her own all night as one of the nurses said "just us two tonight then dear".
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    • pogofish
    • By pogofish 22nd Sep 16, 12:07 AM
    • 5,933 Posts
    • 5,777 Thanks
    pogofish
    I've managed to get home same day by myself after my last three osteo ops without any great problem, so here are my suggestions:


    Do talk to both the surgeon and the anesthetist on the day about this, explaining why you need to get home early. You can talk to them at pre-op but the docs doing that tend to be more junior and limited in the decisions/promises they can make.

    The surgeon themselves can often be much more reasonable about OKing a prompt unaccompanied discharge than the nursing staff/ward doctors and if forewarned, there are sometimes choices the anesthetist can make that will help make your recovery from the anesthetic/sedation more prompt. You will also need to have the OK from both of them and IME, its the anesthetist's word that carries the most weight, so you won't be allowed out until they come back to review you unless they have left prior instructions about your discharge and sometimes anesthetists can have longer lists than individual surgeons, so it can take quite a while for them to get back to the ward.

    Expect them to give you a number of targets/conditions to meet that will indicate you are fit for discharge and meet them as soon as you safely/comfortably can. Also expect them to have you hang-on a bit longer than needed once you do feel able to go. They just want to be sure. Depending on procedure, you may need to see a physio post-op as well.

    Personally I have also found that declining any pre-med can help you feel sharper much quicker but you have to weigh that choice carefully if anxiety is getting the better of you.

    Always take a taxi of course and it helps if you don't live too far from the hospital.
    Last edited by pogofish; 22-09-2016 at 12:16 AM.
    • nanny beach
    • By nanny beach 23rd Sep 16, 3:57 PM
    • 31 Posts
    • 42 Thanks
    nanny beach
    Last time my OH had a coloscopy he had to have someone with him for 3 days, the leaflet spelt out about risks, bleeding, tearing, reactions to sedation.He suffers from very high anxieties and phobias. Last "proper" operation he had I spoke to the ward manager, he was given a sedative and I accompanied him to the threatre door. Maybe you could speak to the Matron on the unit.
    • teddysmum
    • By teddysmum 23rd Sep 16, 6:19 PM
    • 5,082 Posts
    • 3,101 Thanks
    teddysmum
    Last time my OH had a coloscopy he had to have someone with him for 3 days, the leaflet spelt out about risks, bleeding, tearing, reactions to sedation.He suffers from very high anxieties and phobias. Last "proper" operation he had I spoke to the ward manager, he was given a sedative and I accompanied him to the threatre door. Maybe you could speak to the Matron on the unit.
    Originally posted by nanny beach
    I think yours was a special case, as I was fine next day having slept for hours on getting home.(I was slow coming out of sedation and had to stay an extra half hour, although my husband had arrived to collect me.)
    • Mrs_Ryan
    • By Mrs_Ryan 24th Sep 16, 12:05 AM
    • 9,471 Posts
    • 16,897 Thanks
    Mrs_Ryan
    I had my gallbladder out last year and I had to actually change the date of the op. It was booked for the first day of my OH's leave but they rang me and just said 'oh we're changing it to the following week' I said that's fine but as long as you're aware I will going home on the bus to an empty house as my partner will be at work and due to the location of the hospital a taxi would cost 40-50 which I can't afford! They did change the date back.
    I ended up being admitted anyway as my heart rate was sky high- I have PTSD from a previous op at that hospital and had asked for my op to be elsewhere which it was supposed to be until they sent me a letter on the Friday before the operation (received it on the Saturday) to say I must go to the hospital that caused my PTSD. I told everyone who would listen that my last op in that hospital had been botched and I didn't want to stay there. My anxiety levels were through the roof- it took two anesthetists to sedate me in the end as I was that anxious.
    I can totally understand where you're coming from with this one OP.
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