Authors (including presenting author) :
Hui KY(1), Hui LK(1), Chu WL(1), Law NW(1), Mok YT(1)
Affiliation :
(1)Anesthesiology & Perioperative Medicine, Hong Kong Children's Hospital
Keyword 1: :
Nurse-led discharge
Keyword 2: :
Pediatric PACU
Keyword 3: :
Patient experience
Keyword 4: :
Patient safety
Introduction :
Nurse-led discharge (NLD) programs are increasingly adopted to improve patient flow, reduce hospital stay, and optimize perioperative resources. In March 2024, Hong Kong Children’s Hospital formally implemented a NLD program in its Post-Anesthesia Care Unit (PACU)
Objectives :
(1) To enhance patient experience by reducing discharge time; (2) To enhance patient safety by allowing anaesthetists to concentrate on intraoperative case management.
Methodology :
The NLD program was launched in 2024 with a standardized workflow and protocol developed in consultation with anesthetists. It covers elective day discharge cases classified as ASA I or II, undergoing general, regional, or MAC anesthesia, with no airway involvement or significant bleeding risk. 10 experienced nurses with PRCC-trained, were recruited, trained, and passed competency assessments. Data was retrieved from the Clinical Information System.
Result & Outcome :
In 2024, 1,127 day discharges and 107 NLD were recorded, with a success rate of 90.7%. By 2025, day discharges rose slightly to 1,143, while NLD expanded dramatically to 629 (+487.9%), achieving a higher success rate of 96.5% (+5.8%). The program covered patients from infants to adolescents, the age distribution was: under 1 year (6.6%), 1–3 years (23%), 3–6 years (15.8%), 6–12 years (33.8%), and 12–18 years (20.8%), which highlight its applicability across pediatric groups. Importantly, no incidents or complications were reported, and no complaints were received from patients discharged under the NLD program. In 2024, NLD required 63.9 minutes compared to 61.3 minutes for anesthetist discharge, reflecting the early stage of implementation. By 2025, NLD times decreased significantly to 51.4 minutes (–19.5%), while anesthetist discharge improved more modestly to 55.8 minutes (–9%). This reversal indicates that NLD not only scaled up in volume and success rate but also became faster than traditional day discharge, reducing recovery room stay and streamlining turnover. NLD significantly reduced discharge times, enhancing patient experience and efficiency. Success rates rose with no incidents or complaints, confirming safety standards. Anaesthetists focused on intraoperative case management, while nurses gained autonomy in discharge decisions. Together, these outcomes demonstrate that NLD has evolved from pilot to routine practice.
