Postoperative quality and safety using Efficacy Safety Score (ESS) and a wireless patient monitoring system at the ward: A randomised controlled study.

Erlend Johan Skraastad,Petter Christian Borchgrevink,Tom Ivar L Nilsen,Johan Ræder

doi:10.1111/aas.13492

Abstract

Postoperative pain, side-effects and time to mobilisation are indicators for the quality of postoperative recovery. The aim of this randomised controlled study was to investigate if efficacy safety score (ESS) combined with a wireless patient monitoring system would improve these clinical outcomes for patients at a general surgical ward. The trial included 195 patients randomised to a standard care group (SC-Group) or intervention group (INT-Group) receiving continuous wireless monitoring of vital signs combined with ESS during the first 24 postoperative hours. The primary outcome was time to mobilisation. Secondary outcomes were average pain, doses of postoperative opioids, unscheduled interventions, side-effects, patient satisfaction and length of hospital stay (LOS). Mean time to postoperative mobilisation was 10.1hours for patients in the INT-Group compared to 14.2hours in the SC-Group; this corresponds to an adjusted hazard ratio of 1.54 (95% confidence interval 1.04-2.28). INT-Group patients received a higher dose of oral morphine equivalents; 26mg vs 15mg, P<.001; reported lower intensity of pain on a 0-10 scale; 2.1 vs 3.3, P<.001; and had higher patient satisfaction on a 5-point scale; 4.9 vs 4.3, P<.001. The LOS was similar between the groups; 71hours in INT-Group vs 77hours in SC-Group, P=.58. No serious side-effects were registered in INT-Group, whereas two were registered in SC-Group. Introducing ESS as a decision tool combined with a wireless monitoring system resulted in less pain, increased satisfaction and more rapid mobilisation for patients in this study. clinicaltrials.gov Identifier: NCT03438578.

Highlights

Judgement of quality of postoperative recovery has changed from single physiological variables to a broader assessment of patient out‐ come, for example, ability to drink, eat and mobilise.[1]
Patient sat‐ isfaction was analysed with Fischer's exact test based on a Chi‐square test, due to low numbers of expected patients in some groups
The rate of mobilisation was 54% higher for INT‐Group compared to SC‐Group at any given time‐point studied, when adjusted for age, American Society of Anesthesiologists (ASA) classification and sex: Hazard ratio 1.54

Summary

Introduction

Judgement of quality of postoperative recovery has changed from single physiological variables to a broader assessment of patient out‐ come, for example, ability to drink, eat and mobilise.[1] To achieve this, adequate and safe treatment of acute postoperative pain is import‐ ant.[2,3] Despite increased attention, postoperative pain is still under‐ treated.[4] A Dutch study showed that 30% of patients had moderate or severe postoperative pain at rest,[5] and in a Norwegian study, 38% reported a mean pain intensity ≥4 on an 11‐point numeric scale.[6].

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Methods

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Conclusion