Table I.

Short stay hysterectomy pathway: Clinical discharge criteria and actions (nurse). The patient should NOT be discharged by a nurse if non-compliant with any of the criteria unless reviewed and sanctioned by a member of the medical staff.

Discharge criterion		Complied (tick box)	Actions if non-compliant
Uncomplicated surgery
Surgery performed without complications (to be defined by surgeon)			-
EBL <500mL			-
Non-conversion to laparotomy			-
Post-operative observations 1
Complied with MEWS chart – stable and normal vital signs and ability to maintain oxygen saturation levels >95% on room air			Escalate to medical staff
Post-operative progress 1
Tolerated oral fluids and light diet without significant nausea / vomiting			-
Adequate control of nausea and vomiting			-
Adequate pain control with an oral regimen based upon paracetamol, NSAIDs and codeine but NO oral morphine required in the preceding 4 hours			-
Voiding spontaneously and emptying the bladder satisfactorily (bladder scan) OR willing to go home with an indwelling urinary catheter (removal within 48 hours)			-
Post-operative examination and tests
Satisfactory abdominal examination = soft, minimally tender, no more than moderately distended (i.e. not tense) and unremarkable (dry and non-gaping) port site wounds			Escalate to medical staff
6 hour haemoglobin level is in the normal range AND has not dropped > 20g/L from the pre-operative level. 3			Escalate to medical staff
Medications to take home
TTO’s prescribed by the medical staff and given to patient with instructions for use
Routine analgesics - NSAIDs / paracetamol: Standard protocol: Ibuprofen 800mg tds x 4 days – BWCH pharmacy will issue 1 box of 24 x 400mg tablets (If contraindicated then alternative e.g. codeine based analgesic - codeine 60mg qds). Patients to be advised to revert to standard 400mg tds ibuprofen dose (buy from supermarket / pharmacy) after 4 days. Patients to be advised to take paracetamol as required (maximum 1g (2 tablets) 4 times per day).
Routine stool softeners - lactulose / senna
Routine antiemetics – cyclizine or ondansetron
Exceptional (only if requested and prescribed by medical staff) – please tick all that apply:			Ignore and strike through if no exceptional TTOs prescribed
□	Opioids
□	Antibiotics
□	Hormone replacement therapy
□	Low molecular weight heparin (clexane / dalteparin – according to standard gynaecology VTE protocol
Post-discharge care
Someone at home to act as a carer for the next 24 hours
Patient phone number recorded to receive a post-operative phone call from the nursing staff the next day
Written patient information and emergency contact numbers given

¹ Minimal 6-hours post-operative observation; ² Escalate to medical staff if unsure or thought to be abnormal; ³ If abnormal medical staff may consider acceptable according to the clinical circumstances (e.g. patient well and: low starting haemoglobin concentration; <20g/L decrease; acute intra-operative bleed only).