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Criterion 3 : Social

Social conditions are important and are addressed by the clinical team at the Shoulder and Upper Limb Unit and by the Pre-Op Assessment team.
Social Criteria include physical or logistical circumstances that would preclude leaving the hospital on the same day. In some cases, social criteria
may preclude the surgeon from conducting the surgery.

Social criteria are considered on a per-case basis. However, social criteria does not include patient preference for an overnight stay.

Social Factors to determine the appropriateness of a day case: 12,13

• The patient must understand the planned procedure and postoperative care and consent to day surgery.

• Following most procedures under general anesthesia, a responsible adult should escort the patient home and provide support for the first
24 hours.

• The patient must have transport organized to take them home, and be accompanied. Patients cannot drive themselves. The patient must also
have easy access to a telephone during the first 48 hours post-surgery.

• The journey time from the hospital to the patient’s home should not exceed 90 minutes. If the patient is otherwise healthy, then a hotel or
relatives’ home near the hospital is acceptable.

Who is involved: Surgeon; Clinical coordinator; Anesthesiologist

When Is Decision made: During final surgical visit
During Preoperative assessment

How is Decision made: The surgeon will ask the patient questions as part of the preparation process for surgery; the patient coordinator also
has a checklist of questions to ask. Based on both interactions and ongoing communication with the patient,
is made about whether the surgery can safely be done as a day case. The anesthesiologist and pre-op nurses also
have an opportunity to weigh in. If the pre-op assessment team has concerns about the surgery as a day
case, the surgeon will be contacted to discuss.

12 Model of Care for Elective Surgery: Improving the Patient Journey National Clinical Program, Health Service Executive Royal College of Surgeons in Ireland, College of Anesthetists
of Ireland, 2013.
13 Verma R, Alladi R, Jackson I, et al. Day case and short stay surgery: 2, Anaesthesia 2011; 66 : pages 417-434.
The Shoulder and Upper Limb Unit