PACU discharge criteria

Scoring Criteria

Modified Aldrete Score (Max 10 points)

Activity (Motor Function)

• 2 points: Moves all 4 extremities voluntarily/on command

• 1 point: Moves 2 extremities voluntarily/on command

• 0 points: Unable to move extremities

Respiration

• 2 points: Breathes deeply, coughs freely

• 1 point: Dyspnea, shallow/limited breathing

• 0 points: Apneic

Circulation (Blood Pressure)

• 2 points: BP ±20mmHg of baseline

• 1 point: BP ±20-50mmHg of baseline

• 0 points: BP >±50mmHg of baseline

Consciousness

• 2 points: Fully awake

• 1 point: Arousable on calling

• 0 points: Not responding

Oxygen Saturation

• 2 points: SpO₂ >92% on room air

• 1 point: Needs O₂ to maintain SpO₂ >90%

• 0 points: SpO₂ <90% even with O₂

Discharge Criteria

• Standard: Aldrete Score ≥9

• Acceptable: Score ≥8 (if pre-op BP abnormal)

Additional Assessment Requirements

• Pain: Controlled with oral analgesics

• PONV: Absent or controlled

• Surgical site: No excessive bleeding, dressing intact

• Urinary function: Required after spinal/epidural

Absolute Contraindications to Discharge

• Hemodynamic instability

• Respiratory compromise requiring ventilation/high-flow O₂

• Altered mental status

• Uncontrolled pain requiring IV analgesics

• Active bleeding/surgical complications

• No adequate home support

Discharge Destinations

• Phase II Recovery: Stable but not meeting full criteria

• Home: Full criteria met + responsible escort + oral pain control

• Hospital admission: Complications or high-risk factors

Key Points

• Modified Aldrete Score is standard PACU discharge tool

• Score ≥9 required for safe discharge

• Must assess beyond score: pain, PONV, surgical site

• Document all assessments and rationale