06 / Patient care
Surgery outside the operating room
Most of surgery happens before the knife and after it: deciding, readying, and owning the patient on the ward. This pillar follows their journey.
The patient’s journey
The simulations
Practice
Is this normal post-op?
Twelve bedside moments, three verdicts: expected, reassess, urgent. The skill of the surgical ward is knowing which bucket a finding belongs in, and the timing logic that decides it.
Is this normal post-op?
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POD 1 after open bowel resection
Temperature 37.9, otherwise well, shallow breathing from pain
The last door
Discharge & follow-up
Discharge is a clinical decision with criteria, not a bed becoming available. The frame fits on one hand:
Physiology
Eating, drinking, walking, passing urine (and wind after bowel surgery); pain controlled on tablets; observations normal for them.
The wound and the plastic
Wound checked and its care explained; every drain, line and catheter either out or with a plan and an owner.
The medicines
Analgesia the patient understands, VTE prophylaxis completed or continued as prescribed, and any changes reconciled.
Safety-netting
The specific comeback triggers said out loud and written down: fever, spreading redness, bleeding, vomiting, worsening pain. A patient who knows when to return is the discharge's real safety margin.
Follow-up
Who sees them, when, and what is still pending, histology above all: a specimen result with nobody assigned to chase it is how cancers get told to answering machines.