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Frequency, nature and timing of clinical deterioration in the early postoperative period

Version 2 2024-06-03, 21:51
Version 1 2018-07-11, 09:49
journal contribution
posted on 2024-06-03, 21:51 authored by S Mohammed Iddrisu, Julie ConsidineJulie Considine, Ana HutchinsonAna Hutchinson
AIMS AND OBJECTIVES: To establish the frequency of clinical deterioration in the early postoperative period in patients who have undergone general or orthopaedic surgery. BACKGROUND: Worldwide, clinical deterioration is a significant problem in acute care settings. Early recognition and response to clinical deterioration is one of the ten National Safety and Quality Health Service Standards in Australia. However, there is limited understanding of the frequency of clinical deterioration in surgical patients. METHODS: A point prevalence study was conducted from September-October 2014. The records of 100 consecutive in patients admitted for orthopaedic (n = 48) or general surgery (n = 52) to a health service in Melbourne, Australia, were audited. The frequency of clinical deterioration episodes was summarised using descriptive statistics. RESULTS: Baseline characteristics of the two patient groups were equivalent except that orthopaedic patients were older than the general surgery patients (median age 71 [IQR 19] years vs. 62 [IQR 17] years). There were 17 medical emergency team calls and 23 calls for urgent clinical review in 28 patients. The main indications for emergency calls were hypotension (26%), fever (19%), hypoxia (15%), tachycardia (13%) and altered blood glucose level (11%). The majority of episodes were managed on the ward, and there were one ICU transfer and no cardiac arrest calls. CONCLUSION: One in four patients experienced early postoperative clinical deterioration. Hypotension was the most common trigger for escalation of care highlighting a need to optimise fluid and haemodynamic management of postoperative patients. RELEVANCE TO CLINICAL PRACTICE: Haemodynamic instability leading to the activation of rapid response systems is very common in the immediate postoperative period. There is the need for locally tailored interventions to optimise fluid management and decrease incidence of further complications.

History

Journal

Journal of Clinical Nursing

Volume

27

Pagination

3544-3553

Location

England

ISSN

0962-1067

eISSN

1365-2702

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2018, Wiley

Issue

19-20

Publisher

WILEY