Evaluation of readiness for discharge from the block 4 operating theatres post anaesthetic care unit

Nxumalo, Mpucuko
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BACKGROUND: The first of the three phases of recovery from anaesthesia following surgery is critical and is associated with a lot of documented complications. The creation of Postanaesthetic Care Units (PACU) has helped introduce a structured environment for the management of the recovery phase following anaesthesia by providing continuous monitoring and assessment of patients’ clinical parameters until they are ready for discharge back to their respective wards. While the SASA practice guidelines (1) mandate that the patients are the responsibility of their anaesthesiologist until they are discharged from recovery, the decision to discharge the patients is often entrusted to the PACU nurses. Structured objective criteria for the assessment of readiness for discharge should therefore be used in the form of a score to effect a safe and timeous discharge of patients from the PACU. The Modified PAR score, recommended by the SASA practice guidelines is objective, reproducible and applicable to most post-anaesthesia situations. OBJECTIVES: The objectives of the study were to describe the Modified PAR (Post Anaesthesia Recovery) scores of patients on admission to the PACU, describe the Modified PAR scores of the patients deemed ready for discharge by the nurses, and describe the Modified PAR scores of the patients determined by the researcher at the time of discharge. Also, to describe the time to discharge for patients who are ready for discharge according to the Modified PAR score, and to correlate the scores recorded by the researcher and those by the nurses when patients were deemed ready for discharge. METHOD: A prospective, descriptive, contextual study design was used. Eighty adult patients presenting for elective and emergency surgery in Block 4(i.e. the main theatres at Charlotte Maxeke Johannesburg Academic Hospital) theatres who met the inclusion criteria were invited to take part in the study. The Modified PAR score was used by the researcher to assess patients deemed ready for discharge by the PACU nurses. The patients’ last clinical indices recorded by the nurses were used to derive the discharge score. Thereafter, the researcher reassessed the patients’ readiness for discharge by re-evaluating their clinical indices and deriving a discharge score. The patients were deemed not ready for return to the ward when their discharge scores were < 9 and deemed ready when the scores were ≥ 9. Those patients deemed not ready for discharge by the researcher were kept in the PACU until they had met the criteria for discharge. RESULTS: Thirty two (40%) patients were admitted to the PACU with scores of ≥ 9. Eleven (13.75%) patients deemed ready for discharge by the nurses were not ready according to their Modified PAR scores of < 9. Sixty nine (86.25%) patients had Modified PAR scores ≥ 9, meeting the criteria for discharge. The researcher’s reassessment of the patients yielded similar results to those derived from the PACU nurses’ assessments. Patients admitted to the PACU with scores ≥ 9 spent a mean time to discharge of 21.56 minutes (SD=11.16 minutes) and the time range was 5-45 minutes indicating a prolonged length of stay after readiness for discharge. A strong correlation was determined between the Modified PAR scores derived from the indices as recorded by the nurses and those by the researcher which was statistically significant(r=0.7243, p<0.001). CONCLUSION: The use of Modified PAR score should be formally implemented when discharging patients from the PACU. This will ensure that the patients are discharged safely and timeously.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree, Masters of Medicine in Anaesthesia