Requirement of medical escorts in ambulatory surgery

This article covers the injustice of the requirement for "medical escorts," also known as "responsible adults," for ambulatory surgery procedures in medicine.

## Background

In modern medicine, the use of ambulatory surgery, also known as outpatient surgery, has been growing. Many medical procedures that in the past required a hospital stay or extended admission for the patient have instead changed to using **ambulatory surgery centers (ASCs)** to perform the procedures and discharge the patient on the same day. For example, colonoscopies are now typically done in outpatient centers, as are some dental operations.

Ambulatory surgical procedures typically require some kind of anesthesia / sedation. This may include conscious sedation, general anesthesia, or other types of anesthesia. Being sedated carries a risk that the patient will be impaired mentally and physically for some amount of time after the procedure. The patient might not be capable of performing certain daily tasks including driving, caring for oneself, and calling emergency services in case of an emergency.

## Description

Increasingly, these ambulatory surgery centers (ASCs) require that patients have a **medical escort**, also known as a **responsible adult**, to drive the patient home after being discharged from the facility. This escort is typically expected to be a family member or close friend of the patient. The escort is expected to be someone whom the patient trusts. The escort is expected to guide the patient into his/her home, and oftentimes to also provide post-surgical care at home for the patient.

Numerous studies have been done regarding the need for medical escorts after ambulatory surgery, the liability of ASCs in discharging patients with vs. without medical escorts, and the potential for harm to occur when patients are discharged without an escort. In addition, ASCs have been sued for disasters, such as car accidents, that occurred after patients were discharged without a medical escort.

As a result of these studies and lawsuits, many ASCs have implemented draconian policies in requiring medical escorts, including verifying before the procedures that patients have escorts, and contacting the escorts by telephone. Many ASCs will now cancel and refuse to do procedures for patients without medical escorts.

The requirement for medical escorts has been shown to limit many patients' ability and access to obtain medical procedures that they need. This can be due to any number of factors: many people do not have family members and friends, their family and friends might not be available to serve as medical escorts, and many patients wish to keep medical matters private from family and friends.

In some cases, patients who do not have a medical escort available might be required to do the procedures without sedation, when this option is available; this might result in more pain and discomfort than doing the procedure with the recommended sedation.

## Arguments in favor of regarding as an injustice

The requirement for medical escorts in ambulatory surgery is highly onerous and unfair to patients by forcing them to be dependent on third parties in order to have procedures that they need. Patient privacy and independence are highly important, and it is not right to limit access to necessary medical procedures simply because a person doesn't have a third party that he/she can rely on or wants to use. If a procedure impairs a patient to such an extent, then the patient should be able to be admitted to the facility for the amount of time necessary for the impairment to subside. The surgeries in question should be done on an inpatient basis rather than as ambulatory surgeries, or the facilities should be able to accommodate the patient to stay long enough to regain pre-surgical independence.

Ambulatory surgery really benefits the insurance companies rather than the patients because it shifts the burden and cost of post-surgical care to families and friends. The facilities should be required to provide the post-surgery care and the insurance companies should potentially be required to cover this care. This would allow the patient to maintain full independence from third parties.

Requiring escorts may be considered discriminatory with regard to people's familial and social situations. Regardless of whether or not a patient might be able to find someone suitable in his/her life to serve as an escort, patients should have the right and choice to be "private" people and not involve family/friends in their medical care. Providing perioperative medical care related to the procedure should be the job of the medical professionals.

Many patients have echoed these concerns on numerous Web forums, and studies have shown that the requirements for medical escorts are a limiting factor for many people to have access to the surgeries that they need.

## Arguments against regarding as an injustice

Ambulatory surgery reduces costs and increases efficiency in medical care compared to inpatient treatment.