Getting Ready to Go Home
Did you know that the process of getting ready to go home from the hospital starts before you’ve even arrived in the operating room? The discharge process actually starts when you are admitted to the hospital, and you can start learning about and planning for discharge from the moment you arrive. There are lots of things that you can do to be sure that you’re ready and safe to leave the hospital after your operation.
When are you ready to go home?
Your surgical team will want you to meet certain milestones before you leave the hospital. Even if you have a minor operation with general anesthesia, it can leave you feeling fatigued and uncomfortable for weeks after surgery. You won’t go home feeling perfectly normal or the way you did coming in to the hospital. But you should be able to do all of these things before you go home:
Walk on your own: Try to get up and walk as soon as possible after your operation. At first, get your nurse to help. But as soon as you’re cleared by your surgical team, walk on your own, practice getting in and out of bed, and try to spend as much time as possible out of bed. If you are having trouble getting up and moving, your team may enlist the help of physical and occupational therapists to help you move and to assess whether you’ll be safe when you go home or whether you will need a skilled nursing facility or rehab unit.
Not need supplemental oxygen: Unless you were already using oxygen at home, your medical team will want you to be off of oxygen before you go home. Needing a small amount of oxygen after surgery is common. Work to reduce your need for oxygen by walking, taking deep breaths, using only as much narcotic pain medicine as you need, and breathing into the incentive spirometry device that your nurses provide (a small plastic device that makes your lungs work against resistance).
Be able to eat and drink: Some operations, especially abdominal operations, can stun your intestines for a while and require you to not have anything to eat for several days. And some general anesthetics and medications (particularly narcotic pain medicines) make patients nauseous. Before you go home, your medical team will want to see that you’re able to keep down enough liquids to stay hydrated and eat enough food or liquid calories to stay nourished.
Control your pain with pills: After surgery, it’s common to get your pain medications through your IV. IV pain medicine acts faster, but doesn’t last as long as medications taken by mouth. Before you go home, you’ll need to show that your pain is under good control with medications you can take by mouth at home. Usually you start taking pain medicine by mouth once you are able to eat well — they are much better tolerated when taken with food.
Be passing gas: Especially if you’ve had an abdominal operation, you’ll find that your surgical team is very interested to know when you’ve passed gas from your bottom. The reason for this is that passing gas means that your intestine is open and not stunned from the operations or by narcotic pain medications, a condition known as ileus. Patients often think they must have had a bowel movement before they are discharged. That’s rarely true — after most operations, passing gas is enough to show that your intestine is awake and active.
Be able to pee: For long operations, your surgical team will usually place a tube into your bladder, called a Foley catheter, to drain urine. These catheters are often left in place after your operation, and removed after a day or two when you’re up and moving around. Having a catheter can cause inflammation that makes it hard to pee after the catheter is removed. Narcotic pain medicines and some epidural anesthetics can also make it hard to empty your bladder. Usually your surgical team will want you to be able to empty your bladder on your own before you go, but sometimes people need to go home with a catheter in place.
Learn how to care for yourself at home: This is a blog post unto itself — my next one, in fact. In short, some patients have to manage various dressings, devices, and drains at home. Before you leave the hospital, your care team will want to see you show that you’re able to do these things safely and easily. Check back here soon for more details.
These are the hurdles you’ll have to get over before you can go home, but not all things you’ll have to do to get out of the hospital. If you’re not able to meet some of these requirements, your team may advise that you spend some time in a skilled nursing facility or rehab program. But with good planning and coordination by patients and providers alike, the vast majority of patients are able to go home soon after surgery.
This story originally appeared in the Health Dialog Care Compass Blog.