Background

The safe release of a patient from hospital care after bariatric surgery depends upon satisfactory health status. Here we describe a novel ordinal scale Readiness for Discharge (RFD) to measure the patient’s suitability for hospital discharge after bariatric surgery.

Methods

Nursing staff monitored five RFD Scale components (ambulation, vital signs, pain, nausea, and oral intake of clear fluid; see Table) in 23 patients who underwent sleeve gastrectomy. Each component was scored as “1” (satisfactory) or “0” (not satisfactory) and scores were summed. RFD was recorded by nursing staff every 4-8 hours following surgery in awake patients until a score of 5 was achieved (i.e., all items rated as satisfactory), marking the patient as ready for discharge.

Results

Individual patients: In some patients, recurring pain or nausea followed by treatment caused RFD oscillation. In others, RFD5 was recorded repeatedly over 12-16 hours, suggesting that RFD5 did not guarantee hospital discharge. Group observations: All patients achieved RFD5 prior to discharge. The median time from end of surgery to RFD5 was 27 [9-72] hours. Oral intake of 450ml liquid was the last factor to be judged satisfactory in more than 50% of patients. Other observations: Upon implementation, nursing staff quickly adopted the RFD and clinical team communications about patient status soon included RFD ratings.

Conclusions

The RFD Scale is a novel quantitative measure of the patient’s readiness for release from the hospital following bariatric surgery. Validation is needed to support the adoption of the RFD on a wider scale.