Post-anaesthetic discharge scoring criteria: A systematic review

Abstract

Aim This systematic review investigates the essential components of an effective and feasible scoring system to assess patients following anaesthesia and surgery, thereby enhancing patient safety through timely and appropriate discharge from the Post-Anaesthetic Care Unit. The findings of the evidence synthesis will be used to inform the development of a Post-Anaesthetic Care Unit discharge tool. Methods A systematic review of quantitative research conducted in adult populations on post-anaesthetic discharge assessment strategies utilised in post-anaesthetic care units following any type of surgical procedure. An extensive literature search was constructed to identify all relevant studies published between 1970 and 2010. Studies were appraised and data was extracted by two reviewers using the standardised critical appraisal and data extraction tools from the Joanna Briggs Institute. Results A total of eight studies were included in the review. One randomised controlled trial and four observational studies provided evidence on the effectiveness and feasibility of discharge assessment tools. All studies identified pain, conscious state, and nausea and vomiting as important variables to consider in assessing a patient‟s readiness for discharge from the post-anaesthetic care unit. Two additional observational studies and a retrospective records analysis investigated the recovery of patients in the post-anaesthetic care unit, providing data on psychomotor and cognitive recovery following anaesthetic. Conclusion There was general agreement amongst the studies that post-anaesthetic care unit discharge assessment should consider levels of pain, conscious state, and nausea and vomiting. Although vital signs were included in all the discharge assessment tools, there was variation in the specific vital signs included within tools, with blood pressure being the only vital sign consistently used. The value of including urine output, oral intake or psychomotor testing in assessing readiness for post-anaesthetic care unit discharge was inconclusive and therefore requires further investigation.