Quality of post-anesthetic care in a hospital without a Post-Anesthetic Care Unit. A clinical audit.

AIM

The majority of Italian hospitals are not equipped with a Post- Anesthetic Care Unit. The aim of this study is to evaluate whether it is possible to guarantee post-anesthetic care according to current international quality and safety standards in the absence of such a structure.

METHODS

Our hospital is not equipped with a Post-Anesthetic Care Unit and post-anesthetic assistance is assured by the anesthetist and anesthetic nurse themselves. In order to evaluate the quality of the post-anesthetic care a Recovery Chart was devised and strict discharge criteria defined: Recovery Score (modified Aldrete's score) = or >7; systolic blood pressure within 20% of the preoperative values; nausea/vomiting and shivering absent; pain absent/mild. A retrospective audit was conducted in 2 orthopedic operating rooms from January 10, 2000 to January 31, 2001 in order to evaluate major complications, observance of discharge criteria, postanesthetic care time.

RESULTS

Incidence of complications was 2.6%. Observance of discharge criteria was 74%. In 26% of cases (69/261 cases) discharge criteria were not completely respected: 14 cases with unstable vital parameters; 46 cases with pain not under control; 6 cases with nausea/vomiting; 3 cases with shivering. In these cases monitoring and treatment was continued on the ward according to the anesthetist's prescriptions. None of these patients died or suffered major complications because of a quick discharge to the ward. Mean post-anesthetic care time was 40+/-18 minutes (median 35 minutes).

CONCLUSION

Where the Post- Anaesthetic Care Unit is not available it is virtually impossible to guarantee post-anesthetic care according to current international quality and safety standards, because production pressure can lead the anesthetist to discharge the patient to the ward before he/she is completely stabilized. In these cases the anesthetist must accurately prescribe the necessary postoperative monitoring and treatment (analgesics, antiemetics, fluids, etc.) that must be continued in the surgical ward to guarantee the patient's safety, but it must be underlined that the surgical ward is not the appropriate place to carry on immediate post-anesthetic care.