FUNCTION:  Continuum of Care
 
TITLE:  Admission to Day Surgery Unit/Hospital
_________________________________________________________________
 
PURPOSE:
 
To establish criteria for admission to Day Surgery.  Criteria for admission to
Day Surgery will be established and followed.
 
POLICY:
 
1.   The care of patients who receive surgical and anesthesia services will be
     performed by licensed independent practitioners with appropriate clinical
     privileges.
 
2.   The services required must be able to be done on an outpatient basis with
     eligibility determined by the admitting physician and anesthesiologist
     using the approved procedure list as a guideline.
 
3.   Dentists and podiatrists with surgical privileges must have a history and
     physical performed prior to surgery for their patients by a physician on
     staff.  The History & Physical may be documented on the Short Stay Form
     or dictated and may be performed up to 7 days prior to the scheduled
     procedure.
 
4.   Laboratory recommendations:
                              
     a.   Local Anesthesia:  No recommended lab work;  however, the physician
          may require lab work at his/her discretion.
     b.   General Anesthesia (spinal or other major regional anesthesia and/or
          intravenous, intramuscular or inhalation sedation/analgesia):  It is
          recommended that a CBC be done prior to the scheduled procedure.  If
          tests were done prior to admission of the patient, the responsible
          physician shall document this on the patient's chart or bring
          results for the chart.
 
5.   An unemancipated minor must be accompanied by legal guardian to receive
     patient care and for the signing of the consent.
 
6.   The Day Surgery patient will report to the Ambulatory Care Unit one to
     two hours prior to surgery to allow adequate time for the admission
     process.
 
7.   Prior to patients entering the operating room, all charts should contain
     completed history and physical, diagnosis and procedure, signed and
     witnessed operative consent, results of lab work, EKG, chest x-ray or
     other studies ordered by the physician.  Any studies ordered by the
     physician and not competed would be done prior to the commencement of the
     surgery.  An exception will be blood studies sent to another laboratory. 
     If the history & physical form is not completed, a notation should be
     made on the order sheet or progress note of the dictation that has been
     completed. Any abnormality should be noted in writing if the physician
     has chosen to dictate.
 
8.   If pre-op studies are not completed and/or results are not on the chart
     prior to surgery, surgery may be postponed, the attending physician and
     anesthesiologist will be notified and necessary action will be taken to
     obtain results.
 
9.   Reports on a patient scheduled for surgery shall be made available to the
     practitioner responsible for the patient before the surgery is performed.
                              
     a.   The physician should be notified of any abnormal pre-op studies as
          soon as these results are available.
 
10.  The patient should see his/her physician and anesthesiologist prior to
     commencement of surgery.
 
11.  Whenever possible, a family member should be available to Pediatric
     patients during the pre and post-operative period.
 
12.  The patient should finalize financial arrangements with the hospital
     prior to the admission.
 
13.  Prior pertinent medical record information should be available to the
     attending physician and other authorized individuals upon request.
 
14.  A medical record will be maintained for every patient receiving
     ambulatory care services.
 
 
I.   COMMUNICATION TO FAMILY IN SURGICAL WAITING ROOM
 
 
PURPOSE:
 
To allow informed communication between the Day Surgery holding area and
family members/friends in the waiting area.
 
POLICY:
 
R.N./ Day Surgery Personnel
 
1.   Will maintain good communication with the Customer Relations Coordinator
     and volunteers manning the desk located in the waiting area.
 
2.   Will inform family members/friends of any delays regarding the scheduled
     procedure.
 
Surgeon 
 
3.   Will notify family member/friends when surgery is completed.
 
Day Surgery Personnel 
 
4.   Will inform family members/friends when the patient has been assigned a
     twenty-three hour observation room or has been transferred to Post
     Recovery.
 
II.  ADMISSION OF DAY SURGERY PATIENTS INTO THE HOSPITAL.
 
Guidelines for the admission of patients from the Day Surgery unit into the
Hospital:
 
1.   When a patient's condition becomes unstable, the primary physician will
     be notified and an order for the admission to the hospital obtained.
 
2.   The physician's order to admit will be written on the physician's order
     sheet, Form HV-260A.
 
3.   The O.R. nurse or nurse in post-operative areas will note observations
     and the reason for hospitalization in the nurse's notes.
 
4.   Obtain hospital room assignment from the Admitting Office.
 
5.   Report on patient condition as given to the nurse responsible for the
     patients care.  The Outpatient Records will be completed and forwarded
     with the patient to the receiving unit to become a part of the in-house
     chart.
 
6.   The patient who is transferred directly from Recovery Room to an
     inpatient Nursing Unit will be transferred via stretcher.  The patient
     who is transferred from Post-Recovery Lounge to an inpatient Nursing Unit
     may be transferred via wheelchair, if able.