Discharge Dilemma Ambulatory Surgery Centers Face: Your Patient is Ready to Go, but their Ride is Not
Picture this: a patient has finished an outpatient procedure and is ready to go home. But their ride fell through, or they have no one to drive them home. Maybe they live alone and figured they'd call an Uber. Maybe they're unhoused and the question of "who's taking you home" has no easy answer. It happens often and it puts clinical staff in an uncomfortable spot. Do you let them go? Do you delay the procedure if they say up front they have no one to help? What does the policy say? Getting it wrong can have serious consequences, from a patient falling in the parking lot to legal liability for the organization.
Experts in safety and risk management from ECRI – Anna Thomas and Jackie Ferenschak – tackled this question in the peer-reviewed journal Patient Safety, offering guidance grounded in current regulations, accreditation standards, and the latest evidence.
Read the full article, published in Patient Safety (Vol. 8, No. 2, 2026): Should Patients Be Accompanied When Discharged From Ambulatory Surgery?
Key Takeaways
- The safest default is always discharge with a responsible adult after anesthesia or sedation. Exceptions need to be rare, structured, and backed by real safeguards, not improvised in the moment.
- Health equity matters here. For patients who are unhoused or underserved, the requirement for a responsible adult can become a barrier to care. Preoperative planning should include an assessment of health equity-related discharge barriers, and selecting medications with rapid onset and short duration may be appropriate for patients facing these challenges.
- A pilot study found that rideshare transport can work in some cases, but commercial drivers are not trained to respond to adverse events, and an impaired patient may not be able to communicate if something goes wrong. Rideshare discharge does not fully resolve the safety concern.
What staff should do when a responsible adult isn't available:
- Review your organization's discharge policy to ensure it addresses alternatives for patients who arrive without an escort, and that the policy reflects current federal, state, and local regulations
- If a patient insists on leaving with a rideshare or taxi against your clinical recommendation, notify the surgeon, have the patient sign an Against Medical Advice (AMA) form, and file a patient safety event report
- For patients who are not candidates for unaccompanied discharge, determine in advance whether medical transportation can be arranged, whether the patient should be admitted for observation, or whether the procedure should be rescheduled.
- Ensure patients are informed at the time of scheduling that a responsible adult will be required, and verify the plan is in place before the procedure begins
- Partner with legal counsel to confirm that your informed consent policy for unaccompanied discharge is compliant with applicable regulations