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Discharge decision making to detect clinical deterioration: Outcomes from the PACT study.
conference contribution
posted on 2016-05-20, 00:00 authored by Maryann Street, Nikki PhillipsNikki Phillips, Mohammadreza MohebbiMohammadreza Mohebbi, Bridie KentBridie KentIntroduction
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.
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.
