Post-anaesthetic discharge scoring criteria: A comprehensive systematic review.

Abstract

This review will systematically examine the evidence to answer the question: • What are the essential components of an effective scoring system to assess patients, following anaesthesia and surgery, thereby enhancing patient safety through timely and appropriate discharge? The key objectives to be addressed are: 1. To identify the most commonly used predetermined PACU discharge criteria, which can be used, predominantly but not exclusively, by nurses to assess patient readiness for discharge from PACU. 2. To investigate whether some variables have greater relevance than others in terms of determining readiness for discharge. 3. To develop, from the evidence synthesis, a draft of a discharge tool that can be later submitted for review by a panel of experts to establish content validity Inclusion criteria Types of participants The review will consider studies that include adult patients (over 18 years of age), male and female, who have received care in the PACU for any type of surgery, planned or unplanned. Types of Interventions The review will consider studies that evaluate variables suitable for assessment of patient readiness for discharge from the PACU. This will include studies evaluating both individual and grouped predetermined discharge criteria; for example, measure of vital signs (temperature, respiratory rate, heart rate, blood pressure) and /or return to pre-operative baseline, capillary oxygen saturation, assessing level of consciousness, blood loss, pain assessment, and existing tools for discharge. Type of Outcomes This review will consider studies that include variables for patient assessment, examples of which are the following outcome measures: • stable vital signs and/ or stable capillary oxygen saturation • presence or absence of nausea and/ vomiting • pain score • medication administration (such as anti-emetics and analgesics) • PACU time • PACU discharge delay • adverse events related to early discharge from PACU, e.g: o complications that may have been avoided (eg. medical emergency team (MET) calls) o unexpected admissions to intensive care, critical care or high dependency units o readmission rates (to theatre or hospital) o increased length of hospital stay