An unaccompanied patient who received propofol wants to leave your facility in a taxi? Would you let him? An anesthesiologist posed this question to Outpatient Surgery's Second Opinions board, saying one of this GI physicians would like to send some patients this way. "His reason is, since they'd only received propofol and no other drugs, the propofol should be cleared within minutes and they'd be OK to be discharged by themselves." Our respondents all seemed to agree — it's not a good idea.

Many note that CMS and accreditation agencies require that all patients who receive any kind of sedation after surgery be released to "a responsible adult."

"Discharging a patient via taxicab is a safety risk for the patient as well as the facility," says one OR manager. "The national standard is for patients to be discharged accompanied by a responsible adult (someone who will resume responsibility for safe care during the recovery period)."

Others note that letting a patient go without a responsible adult — most argue a cab driver would not count — would mean that the provider and facility would be liable if something bad were to happen.

"Absolutely no. It still takes time for medications including propofol to wear off… Imagine if the patient took a taxi home and with [his] slower response time got hit by a car, and severely injured or died," says Paul Rein, DO, an anesthesiologist in Virginia.

"I don't know of any cab driver that is willing to sign a discharge sheet saying he is 'responsible' for said patient," writes one OR manager.

One reader said that while the facility does not release patients to taxis, they do use a "medical transport service." Others note that it's important to be sure arrangements for escorts are made before the day of surgery.

"This should be ascertained pre-procedure (responsible adult available)," says one anesthesia provider. "If none, then no procedure."

Kendal Gapinski