An audit of the time spent by patients in the post anesthetic care unit before and after the introduction of a discharge criteria scoring system at Tygerberg Academic Hospital

Dwyer, Sean (2014-04)

Thesis (MMed)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: BACKGROUND Post anesthesia discharge criteria scoring systems have been used successfully to aid discharge from the post anesthetic care unit (PACU) for over 40 years. They do not replace, but rather act in conjunction with good clinical judgment, and provide concise, standardized documentation of a patient’s readiness for discharge. 1,2,3,4,5 In order to improve patient safety, provide clear documentation and to aid future audit, a discharge criteria scoring system was developed for use in our PACU (Addendum A). It is a modification of the Aldrete Scoring System and the modified Post Anesthetic Discharge Scoring System (PADSS) proposed by Chung.1 There is a steadily increasing patient burden on the existing medical infrastructure in South Africa. Tygerberg Academic Hospital is no exception, and because of the high demand on our theatre services, optimal efficiency is essential. We speculated that our discharge criteria scoring system might increase the efficiency of our PACU when compared to the traditional time based system. The more healthy patients, undergoing minor procedures, could potentially spend less time in PACU, allowing the nurses to focus on problem cases. Increasing the speed of transit might also help prevent delays in theatre due to lack of bed space in PACU. Our primary endpoint was to compare the duration of time spent by patients in the PACU at Tygerberg Academic Hospital, from the moment they are admitted, to the time they are discharged to the ward, before and after the introduction of a discharge criteria scoring system. While planning the audit, one of the factors that staff identified as contributing to delayed discharge from PACU, was the time it took for the wards to collect their patients. A secondary objective, therefore, was to assess the amount of time that elapsed between calling the ward to collect the patient, and the patient leaving PACU. METHODS AND MATERIALS Prior to commencing the audit, approval was obtained from the Human Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch and Tygerberg Academic Hospital. The Audit, its purpose and possible benefits, was discussed with representatives of the nurses working in PACU, and written consent was obtained from those who would be involved in the data collection (Addendum B). Audit forms (Addendum C), collection boxes, and posters reminding staff to participate in the audit were prepared. Our first audit was performed over approximately a week in August 2012. During this period, the traditional time-based discharge system was still in operation. Data was captured from 327 patients. Audit forms were placed in a collection box, which was cleared daily by the primary investigator. The discharge criteria scoring system was introduced to the PACU staff in January 2013. The nurses were trained in its use, and a one month period was allowed for all involved to become accustomed to the new system. A second audit was performed in February 2013, again over a week, during which we gathered data from 313 patients. RESULTS The median value of the time spent by patients in the PACU decreased from 1 hour 25 minutes, to 1 hour 15 minutes, after introduction of the discharge criteria scoring system. This was statistically significant (p-value = 0.003). The median time between calling the ward to collect a patient, and the patient leaving recovery, was 15 minutes. CONCLUSION The main finding of the study was that the introduction of a discharge criteria scoring system decreased the median duration of time spent by patients in the post anesthetic care unit at Tygerberg Academic Hospital.

AFRIKAANSE OPSOMMING: AGTERGROND Puntestelsels as ontslag kriteria na narkose, word vir die afgelope 40 jaar suksesvol gebruik as maatstaf om pasiënte uit die herstelkamer te ontslaan. Hierdie kriteria vervang nie goeie kliniese oordeel nie, maar is ’n addisionele hulpmiddel om te bepaal of die pasiënt gereed is vir ontslag en om noukeurige, gestandardiseerde dokumentasie te verseker. 1,2,3,4,5 'n Nuwe puntestelsel vir ontslag is vir die herstelkamer van Tygerberg Akademiese Hospitaal ontwikkel om pasiëntesorg en dokumentasie te verbeter, asook om ouditering in die toekoms te vergemaklik (Addendum A). Hiervoor is die Aldrete Scoring System en die gemodifiseerde PADSS, voorgestel deur Chung, aangepas. 1 Die bestaande mediese infrastruktuur in Suid-Afrika beleef tans ‘n geleidelike toename in die getal pasiënte. Tygerberg Akademiese Hospitaal is geen uitsondering nie en as gevolg van die hoë aanvraag na ons teaterdienste, is uiterste doeltreffendheid noodsaaklik. Ons vermoede was dat hierdie aangepaste puntestelsel doeltreffendheid in die herstelkamer sou verbeter in vergelyking met die meer tradisionele tyd-gebaseerde sisteem. Gesonde pasiënte wat kleiner prosedures ondergaan, sal waarskynlik na ’n korter periode ontslaan kan word wat die verpleegpersoneel in staat sal stel om meer aandag aan probleem gevalle te gee. Bespoediging van die pasiëntvloei behoort onnodige vertragings van teatergevalle weens 'n tekort aan beddens in die herstelkamer, te beperk. Die primêre doel van die studie was om te bepaal of die gebruik van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal, die tydperk wat die pasiënt in die herstelkamer deurbring, verkort. Die herstelkamer verpleegsters het beweer dat die saal personeel ‘n lang tyd gevat het om hulle pasiente in herstelkamer te kom haal. Vervolgens is 'n sekondêre doelwit ingesluit om die tydperk te bepaal vandat die saalpersoneel in kennis gestel word, totdat die pasiënt die herstelkamer verlaat. METODE Goedkeuring is verkry van die Menslike Navorsing en Etiese Komitee van die Gesondheidswetenskap Fakulteit van die Universiteit van Stellenbosch en Tygerberg Akademiese Hospitaal voor die aanvang van die studie. Die studie, asook die doel en moontlike voordele daarvan is vooraf bepsreek met verteenwoordigers van die herstelkamer verpleegpersoneel en skriftelike toestemming is verkry van al die deelnemers wat betrokke sou wees by die data versameling (Addendum B). Oudit vorms (Addendum C), versamelhouers en inligtingsplakkate vir die betrokke personeel is voorberei. Die aanvanklike oudit is in Augustus 2012 oor 'n periode van ongeveer een week uitgevoer. Tydens hierdie oudit is die tradisionele tydgebaseerde sisteem gebruik. Inligting van 327 pasiёnte is versamel. Die oudit vorms is in die versamelbokse geplaas en is daagliks deur die primêre navorser verwyder. Die aangepaste puntestelsel as ontslag kriteria, is in Januarie 2013 in die herstelkamer geïmplementeer. Die verpleegpersoneel het opleiding ontvang waarna die aangepaste puntestelsel vir een maand gebruik is om te verseker dat die personeel vertroud is daarmee. In Februarie 2013, is ‘n tweede oudit oor ‘n tydperk van een week uitgevoer, waartydens inligting van 313 pasiёnte versamel is. RESULTATE Na die implementering van die aangepaste puntestelsel as ontslag kriteria, het die mediane tyd wat pasiënte in die herstelkamer deurbring afgeneem van 1 uur en 25 minute tot 1 uur en 15 minute. Hierdie afname is statities betekenisvol (p-waarde = 0.003) Die mediane tyd vandat die saal in kennis gestel is totdat die pasiënt die herstelkamer verlaat, was 15 minute. GEVOLGTREKKING Die hoof bevinding van die studie is dat die mediane tydperk wat die pasiënte in die herstelkamer deurbring verminder is deur die implementering van die aangepaste puntestelsel as ontslag kriteria in Tygerberg Akademiese Hospitaal.

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