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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

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journal contribution
posted on 2024-06-18, 05:35 authored by Maryann StreetMaryann Street, Nikki PhillipsNikki Phillips, Mohammadreza MohebbiMohammadreza Mohebbi, Bridie KentBridie Kent
ObjectivesThis 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.MethodsA 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).ResultsNursing 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.ConclusionThis 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.

History

Journal

BMJ Open

Volume

7

Article number

ARTN e015149

Pagination

1 - 11

Location

England

Open access

  • Yes

ISSN

2044-6055

eISSN

2044-6055

Language

English

Publication classification

C Journal article, C1 Refereed article in a scholarly journal

Copyright notice

2017, The Authors

Issue

12

Publisher

BMJ PUBLISHING GROUP