Leaving hospital after sedation

[reallymadwoman]

An urgent endoscopy is needed, which will involve sedation. There is only one session a week at the hospital and an appointment has been given for that day but no one is available to collect the patient afterward. The patient has frequently been sedated in the past with no problems whatsoever, home is a 3 minute taxi ride from the hospital, and there will be someone there when they get home.

 

What is likely to happen if the patient omits to mention the lack of someone collecting them until they are ready to leave? Can the staff prevent them from leaving or is it just a matter of signing a form?

 

If they can't make this appointment they will have to cancel a two week holiday as it can't wait until they get back.

[silverfox1961]

Tricky one this. Before the procedure, the patient will be asked if they have anyone to collect them AND stay with them for the 24 hour period after the endoscopy. If that cannot be provided, they shouldn't go on with it.

 

Endoscopy can be done without sedation but it is not recommended as it is a nasty procedure-I know as I tried once!

 

Even without sedation, they would insist on someone being there as there is always the risk of a bleed during the procedure which could be missed.

 

The staff cannot prevent anyone leaving but I think they are wise to this which is why they ask the questions first.

[reallymadwoman]

So it looks like they will have to lie since it really is a matter of a few minutes travelling, in a taxi with a driver who would hopefully notice if anything drastic went wrong. There will be someone with them as soon as they are home, unfortunately that person is housebound so can't physically collect them. Cancelling the procedure really isn't an option, nor is doing it without sedation. Apart from anything else I get the distinct impression that if this appointment were cancelled they wouldn't bother to make another one.

[silverfox1961]

As that is the case, why not ask if they will provide some hospital transport. The driver will be first aid trained, just in case.

[BazzaS]

(3rd party) friend able to "cover" for the bit between leaving endoscopy, the walk to the taxi & the 3 min taxi ride home?

 

No need to lie, no risk of hospital cancelling the procedure?

[reallymadwoman]

There really isn't anyone available to cover those few minutes, and the hospital have been absolutely clear that no companion home = no sedation and patient is clear that no sedation = no procedure. Hospital transport is a good idea, I'll look in to that.

[Conniff]

I pretty sure a porter would wheel them to a taxi.

[reallymadwoman]

Hospital transport proved to be a non-starter so patient was left with no alternative but to be creative when completing the 'who will be collecting you' form.

 

Actually leaving was no problem whatsoever since the waiting area is not supervised at all so he was able to just walk out when no staff were around, having already been told he could leave as soon as his escort arrived. He did of course arrive home safely and the very good news is that it isn't cancer.

[silverfox1961]

Glad it is all sorted and it is good news.

 

By saying an 'escort' would be picking him up, he didn't have to say it was a Ford

 

Anyone who has had sedation should be monitored as some have a tendency to wander off (as I have seen) so 'escaping' while staff were not present doesn't sound too good to me. Staff Cut backs??

[mr_mastiff]

Glad it is all sorted and it is good news.

 

By saying an 'escort' would be picking him up, he didn't have to say it was a Ford

 

Anyone who has had sedation should be monitored as some have a tendency to wander off (as I have seen) so 'escaping' while staff were not present doesn't sound too good to me. Staff Cut backs??

 

Its not really the sedation that is the problem. If I can remember correctly a local anaesthetic is applied to the airway before the endoscope goes down.And this could be a risk post op due to possible blocked airway due to choking.This remains a risk for a period of time after the procedure.

[BazzaS]

Its not really the sedation that is the problem. If I can remember correctly a local anaesthetic is applied to the airway before the endoscope goes down.And this could be a risk post op due to possible blocked airway due to choking.This remains a risk for a period of time after the procedure.

 

I don't agree. The escort isn't trained in airway management.

If they aren't happy the patient can protect their own airway, they shouldn't be discharging them.

 

The escort is because the patient may feel fine but may have delayed reactions for 24 hours, and in case of a (less urgent problem than airway obstruction) problem.

[mr_mastiff]

I don't agree. The escort isn't trained in airway management.

If they aren't happy the patient can protect their own airway, they shouldn't be discharging them.

 

The escort is because the patient may feel fine but may have delayed reactions for 24 hours, and in case of a (less urgent problem than airway obstruction) problem.

 

I agree you are correct, maintaining an airway is not normally a problem and if I can remember correctly post op we would observe them having a drink and warn them to be careful with solid food until the local anaesthetic had totally warn off. I only worked in the department for a short while as a student and 2 out of the three people who returned had problems after swallowing food two quickly post op.

[reallymadwoman]

The staff sit you in the waiting area with a drink and biscuit and return after about 10 minutes with your discharge paperwork at which point I'm sure they'd be worrying if you hadn't managed to drink anything. Despite what it says in the information provided in advance, it wasn't letting the sedative wear off that caused the delay in discharge, it was letting the local anaesthetic wear off which apparently takes up to 45 minutes.

[mr_mastiff]

The staff sit you in the waiting area with a drink and biscuit and return after about 10 minutes with your discharge paperwork at which point I'm sure they'd be worrying if you hadn't managed to drink anything. Despite what it says in the information provided in advance, it wasn't letting the sedative wear off that caused the delay in discharge, it was letting the local anaesthetic wear off which apparently takes up to 45 minutes.

 

It as been a long while since I have had personal experience of working in endoscopy. We would check for gag reflex etc the whole process used would take about two hours. I can remember sitting with patients after the department had closed for the day because of sedation/anaesthetic concerns. It would appear that the procedures have changed. IE get them in and get them out A.S.P.