> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Inpatient and Day Surgery Management
> How to admit patients for eye surgery, manage their stay in a surgical bay or overnight bed, handle nursing care, and process discharge with post-operative instructions.
Many eye care centers run a day surgery service where patients come in on the morning of their procedure and go home the same afternoon. Some procedures (particularly complex retinal surgery or cases requiring general anaesthesia in elderly patients) may require an overnight stay. The inpatient module tracks every admitted patient from the moment they are assigned a bay to the moment they are discharged.
***
## Before You Start
* **Healthcare Service Units** must be set up for your surgical bays, laser rooms, and recovery area (and overnight beds if applicable).
* The patient must have had a consultation where inpatient admission or a procedure was ordered.
* You need the **Healthcare Practitioner** role to create inpatient records.
* The **Nursing User** role handles nursing tasks and medication administration.
***
## Day Surgery vs Overnight Stay
At an eye care center:
| Type | Examples | Typical Duration |
| -------------------------- | ------------------------------------------------------------------------------------------------ | -------------------------------- |
| Day Procedure (No Bed) | YAG laser, intravitreal injection, minor lid surgery | 1-4 hours total |
| Day Surgery (Surgical Bay) | Cataract surgery, LASIK, pterygium excision | 4-8 hours (morning to afternoon) |
| Overnight Stay | Complex retinal surgery, patients under general anaesthesia, elderly patients needing monitoring | 1-2 nights |
Use the Inpatient module for Day Surgery patients (assigned to a surgical bay) and Overnight Stay patients. For short procedures in the laser room or minor procedure room, a Clinical Procedure record alone is sufficient.
***
## Step 1: Admit the Patient
### Order Admission in the Eye Examination
When the doctor decides the patient needs day surgery:
1. In the Patient Encounter, set the **Inpatient Status** to "Admission Scheduled"
2. Submit the encounter
This signals the nursing team to prepare a bay.
### Create the Inpatient Record
1. Go to Healthcare workspace → Inpatient card → **Inpatient Record** → New
2. Fill in the admission details:
| Field | What to Enter |
| ----------------------- | --------------------------------------------------------------------- |
| Patient | The patient being admitted |
| Medical Department | Ophthalmology / Surgery |
| Primary Practitioner | The operating surgeon |
| Admission Ordered For | Date admission was planned |
| Expected Length of Stay | Hours (for day surgery) or days (for overnight) |
| Expected Discharge | Planned discharge time/date |
| Chief Complaint | The surgical indication (e.g., "Right eye cataract affecting vision") |
| Admission Instruction | Pre-op instructions (e.g., "Nil by mouth from midnight if GA") |
### Assign a Surgical Bay or Bed
1. In the Service Unit section, click the bay assignment button
2. The Healthcare Service Unit tree opens - green = Vacant, red = Occupied
3. Select the appropriate bay (OT Bay 1, Recovery Bay 2, Overnight Room 3, etc.)
4. Save
The patient's status on their Patient record changes to **Admitted**.
***
## Step 2: Pre-operative Nursing Care
On the day of surgery, the nursing team completes pre-operative preparation:
1. Go to Healthcare workspace → Nursing card → **Nursing Task**
2. Find nursing tasks for today's surgical patients
3. For each patient, complete:
* Pupil dilation (administer mydriatic drops)
* Blood pressure and blood glucose check
* Surgical site confirmation (right eye or left eye clearly identified)
* Consent confirmed and on file
* IV access established (if required)
* Antibiotic drops given (e.g., Povidone-Iodine)
***
## Step 3: Surgery and Recovery
After the surgical procedure is completed:
1. The surgeon updates the **Clinical Procedure** record with operative findings and outcome
2. The recovery nurse checks and records:
* Initial post-op vision (light perception or better)
* IOP post-operatively (if indicated)
* Wound integrity (no leaking wound, correct position)
* No immediate complications (hyphaema, iris prolapse, choroidal effusion)
3. Post-operative medications administered and documented:
* Antibiotic eye drops (e.g., Moxifloxacin 0.5%)
* Steroid eye drops (e.g., Prednisolone 1%)
* Anti-inflammatory drops (e.g., Ketorolac 0.5%)
4. Eye shield or pad applied as per surgeon's instructions
***
## Inpatient Medication Orders
For admitted patients receiving post-operative eye drops or systemic medications:
1. Open the Inpatient Record
2. Add medications in the Drug Prescription section
3. The nursing team sees these as **Inpatient Medication Orders**
4. Each dose administered is recorded with the time given
For cataract surgery recovery, typical medication schedule:
* Antibiotic drops: 4 times a day for 2 weeks
* Steroid drops: 4 times a day, tapering over 4 weeks
* Anti-inflammatory drops: 3 times a day for 2 weeks
* Any additional glaucoma drops if IOP elevated post-op
***
## Step 4: Discharge
When the patient is ready to go home:
### For Day Surgery Patients (Usually Same Day)
1. The surgeon or recovery nurse confirms:
* Vision is as expected
* No bleeding or wound problem
* Patient is comfortable
* IOP is within acceptable range (for cataract surgery)
2. Post-operative instructions printed and handed to patient:
* Drop instillation schedule
* Activity restrictions (no rubbing, no swimming, no bending)
* When to seek emergency care (sudden pain, sudden vision loss, severe redness)
* Follow-up appointment dates
3. Open the Inpatient Record → fill in discharge details:
| Field | What to Enter |
| ---------------------- | ---------------------------------------------------------- |
| Discharge Practitioner | Surgeon or recovery nurse authorising discharge |
| Discharge DateTime | Actual time the patient left |
| Discharge Note | Summary: operation performed, outcome, any complications |
| Discharge Instructions | Post-op drop schedule, follow-up dates, restriction advice |
| Followup Date | Date of first post-op appointment (typically Day 1) |
4. Submit the Inpatient Record
After submission:
* Patient's Inpatient Status changes to blank on their record
* The bay becomes Vacant for the next patient
* Total Patients Admitted count decreases
***
## Healthcare Service Unit Setup for Eye Care
Typical service units for an eye care center:
| Unit Name | Type | Notes |
| -------------------- | ----------------- | ---------------------------------------------- |
| Operating Theatre 1 | Operating Theatre | Main surgical OT |
| Operating Theatre 2 | Operating Theatre | Second OT or laser room |
| Laser Suite | Procedure Room | For LASIK, YAG, SLT |
| Minor Procedure Room | Procedure Room | For intravitreal injections, minor lid surgery |
| Day Surgery Bay 1-4 | Surgical Bay | Pre-op and recovery bays |
| Overnight Room 1-2 | Room | For patients staying overnight |
***
## Field Guide: Inpatient Record (Eye Surgery)
| Field | What It Contains |
| ----------------------- | ----------------------------------------- |
| Patient | The surgical patient |
| Medical Department | Ophthalmology |
| Primary Practitioner | Operating surgeon |
| Status | Active (admitted), Completed (discharged) |
| Admitted DateTime | When patient arrived in the bay |
| Expected Length of Stay | Hours or days |
| Chief Complaint | Surgical indication |
| Inpatient Occupancies | Bay assignment history |
| Drug Prescription | Post-operative medication orders |
| Discharge DateTime | When patient left |
| Discharge Note | Surgical summary and outcome |
| Discharge Instructions | Post-op instructions given to patient |
| Followup Date | First post-op appointment |
***
## Monitoring Day Surgery
* **Total Patients Admitted** number card: live count of patients currently in bays
* **Vacant Service Units** shortcut: shows available bays for the next patient
* **Inpatient Status** chart on Dashboard: breakdown of active, discharged, cancelled
***
## Troubleshooting
**The bay shows as Occupied but the patient was discharged**
The Inpatient Record may have been saved but not submitted. Submit the record to release the bay.
**Medication orders for post-op drops are not appearing for the nurse**
Check that the medications were added in the Drug Prescription section of the Inpatient Record and that the record was saved.
**The patient's inpatient status is still Admitted after discharge**
Ensure the Inpatient Record was submitted (not just saved). Submission triggers the status change.
***
## Best Practices
* For cataract surgery days, create the Inpatient Records for all patients at the start of the day - this gives the nursing team a clear view of the surgical list from the morning
* Always print post-op instructions and hand them to the patient on discharge - verbal instructions are not enough for a patient whose vision may be blurred from the procedure
* For patients operated under local anaesthesia who drive themselves, inform them they cannot drive the same day - document this conversation in the discharge note
* Book the Day 1 post-op appointment before the patient leaves the clinic - failed Day 1 follow-up is a patient safety risk after intraocular surgery
* If an inpatient complication occurs post-operatively, update the discharge note with the complication details and the management plan - this ensures the doctor seeing the patient at follow-up has complete information
***
## Related Features
* [Surgical Procedures](/health-wellness/eye-care-center/surgical-procedures): The Clinical Procedure record for the surgery itself
* [Eye Examination](/health-wellness/eye-care-center/eye-examination): The examination where surgical admission is ordered
* [Billing and Finance](/health-wellness/eye-care-center/billing-finance): Inpatient billing at discharge