You are here

  • Home
  • Archive
  • Volume 7, Issue 12
  • 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

Article Text

Article menu

Download PDFPDF

XML
Nursing
Research
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
  1. Maryann Street1,2,3,
  2. Nicole M Phillips1,3,
  3. Mohammadreza Mohebbi4,
  4. Bridie Kent5
  1. 1 School of Nursing and Midwifery, Deakin University, Geelong, Australia
  2. 2 Eastern Health-Deakin University Nursing and Midwifery Research Centre, Box Hill, Australia
  3. 3 Quality and Patient Safety Research Centre, Deakin University, Burwood, Australia
  4. 4 Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
  5. 5 School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
  1. Correspondence to Dr Maryann Street; maryann.street{at}deakin.edu.au

Abstract

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.

  • surgery
  • health Economics

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015149

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors MS designed the study, acquired the data, monitored its collection, analysed the data, and drafted and revised the paper. NMP contributed to study design and interpretation of the data. She also assisted with drafting the manuscript. MM contributed to study design, advised with regard to data analysis and reviewed the draft manuscript. BK advised on each aspect of the study, participated in interpretation of the data and critically appraised the draft manuscript.

    • Funding This study was externally funded by the Health Contributions Fund (HCF) Research Foundation, an Australian not-for-profit charitable trust, established to encourage health service research for the benefit of HCF contributors and the public generally.

    • Competing interests None declared.

    • Ethics approval The research project was approved by the Human Research Ethics Committees of the Health Service and Deakin University as a low-risk study and waiver of consent for patients was granted.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.