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Effect of a newly designed observation, response and discharge chart in the post anaesthesia care unit on patient outcomes: a quasi-expermental study in Australia

Street, Maryann, Phillips, Nicole M, Mohebbi, Mohammadreza and Kent, Bridie 2017, Effect of a newly designed observation, response and discharge chart in the post anaesthesia care unit on patient outcomes: a quasi-expermental study in Australia, BMJ open, vol. 7, no. 12, pp. 1-11, doi: 10.1136/bmjopen-2016-015149.

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Title Effect of a newly designed observation, response and discharge chart in the post anaesthesia care unit on patient outcomes: a quasi-expermental study in Australia
Author(s) Street, MaryannORCID iD for Street, Maryann orcid.org/0000-0002-5615-141X
Phillips, Nicole MORCID iD for Phillips, Nicole M orcid.org/0000-0002-6821-4983
Mohebbi, MohammadrezaORCID iD for Mohebbi, Mohammadreza orcid.org/0000-0001-9713-7211
Kent, Bridie
Journal name BMJ open
Volume number 7
Issue number 12
Article ID e015149
Start page 1
End page 11
Total pages 11
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2017-12-03
ISSN 2044-6055
Keyword(s) health Economics
surgery
science & technology
life sciences & biomedicine
medicine, general & internal
general & internal medicine
Summary OBJECTIVES: This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes.

METHODS: A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT).

RESULTS: Nursing response to patients at-risk of deterioration was higher using PACT, with more medical consultations initiated by PACU nurses (19% vs 30%, P<0.001) and more patients with Medical Emergency Team activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, P<0.001). There were higher rates of analgesia administration (37.3% vs 54.2%, P=0.001), nursing assessment of pain and documentation of ongoing analgesia prior to discharge (55% vs 85%, P<0.001). More adverse events were recorded in PACU after introduction of the PACT (8.3% vs 16.7%, P<0.001). The rate of adverse events after discharge from PACU remained constant (16.5%), but the rate of cardiac events (5.1% vs 2.6%, P=0.021) and clinical deterioration (8.7% vs 4.3%, P=0.001) following PACU discharge significantly decreased, using the PACT. Despite the increased number of patients with adverse events in phase 2, healthcare costs did not increase significantly. Length of stay in PACU and length of hospital admission for those patients who had an adverse event in PACU were significantly reduced after implementation of the PACT.

CONCLUSION: This study found that using a structured discharge criteria tool, the PACT, enhanced nurses' recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.
Language eng
DOI 10.1136/bmjopen-2016-015149
Field of Research 111099 Nursing not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30109230

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.