Discharge decision making to detect clinical deterioration: Outcomes from the PACT study.

Introduction Intensive observation of patients by nurses in PACU may lead to early recognition and response to clinical deterioration, reducing post-operative complications and length of hospital stay. This study aimed to evaluate whether use of the Post- Anaesthetic Care Tool (PACT) would enhance nurses’ recognition of and response to patients at-risk of deterioration and improve patient outcomes. Method A non-randomised prospective study at three hospitals of nursing management in PACU for adults undergoing elective surgery before and after the introduction of criteria to aid recognition and response to clinical deterioration. Patient outcomes were determined from the medical record following hospital discharge. 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 (MET) activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, p<0.001). There were higher rates of analgesic administration (37.3% vs 54.2%, p=0.001), nursing assessment of pain and documentation that ongoing pain relief had been ordered prior to discharge (55% vs 85%, p<0.001). Fewer adverse events were recorded in PACU before PACT (4.3% vs 12.3%, p<0.001). However, the rate of adverse events after discharge from PACU remained constant (16.5%), and 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. Conclusion The PACT study has demonstrated that using this PACU discharge tool enhanced nurses’ recognition and response to patients who experienced clinical deterioration following surgery.