采用麻醉后出院标准以减少麻醉后护理单元中住院患者的出院延迟。

Use of postanesthesia discharge criteria to reduce discharge delays for inpatients in the postanesthesia care unit.

作者信息

Brown Irwin, Jellish W Scott, Kleinman Bruce, Fluder Elaine, Sawicki Kris, Katsaros Jeri, Rahman Raed

机构信息

Department of Anesthesiology, Loyola University Medical Center, Maywood, IL 60153, USA.

出版信息

J Clin Anesth. 2008 May;20(3):175-9. doi: 10.1016/j.jclinane.2007.09.014.

DOI:10.1016/j.jclinane.2007.09.014

PMID:18502359

Abstract

STUDY OBJECTIVE

To determine whether a set of predetermined discharge criteria, used by nurses, shortens the length of patient stay in the postanesthesia care unit (PACU) without compromising safety.

STUDY DESIGN

Prospective clinical study.

SETTING

Postoperative recovery area of a large, tertiary-care, academic hospital.

PATIENTS

1,198 adult, ASA physical status I, II, and III patients, 18 years or older, requiring general anesthesia.

INTERVENTIONS

Two groups of inpatients were followed. In the first group, over a 90 day period, all inpatients meeting study inclusion criteria were discharged by a physician (traditional discharge group [TDG]). This period was followed by a subsequent 90 day period in which a second group of patients were discharged by a PACU nurse using predetermined discharge criteria (discharge criteria group [DCG]).

MEASUREMENTS

Demographic and discharge variables, including the time when the physician was called for an order, the time a discharge order was written, and the actual discharge time, were recorded. Other comparisons of various discharge variables included the time that discharge criteria were met, the actual discharge time, and the difference between these times. The frequency of PACU stays longer than 60 minutes, PACU discharge delays, and the time discharge criteria were met longer than 60 minutes were also compared between groups. Floor nurse satisfaction with patient status and any related morbidities noted were also measured.

MAIN RESULTS

Length of PACU stay was significantly shorter (133.1 +/- 91.4 vs 101.7 +/- 53.7 min; P < 0.05) for inpatients in the DCG group. Discharge delays were higher with physician discharge. The DCG had a lower number of patients with multiple delays. There was no significant difference in the occurrence of adverse events between the two groups.

CONCLUSIONS

Predetermined discharge criteria resulted in a 24% decrease in PACU time.

摘要

研究目的

确定护士使用的一组预定出院标准是否能缩短患者在麻醉后护理单元（PACU）的住院时间，同时不影响安全性。

研究设计

前瞻性临床研究。

研究地点

一家大型三级医疗学术医院的术后恢复区。

患者

1198例18岁及以上、美国麻醉医师协会（ASA）身体状况分级为I、II和III级、需要全身麻醉的成年患者。

干预措施

对两组住院患者进行随访。第一组，在90天期间，所有符合研究纳入标准住院患者由医生办理出院（传统出院组[TDG]）。在此期间之后的90天里，第二组患者由PACU护士依据预定出院标准办理出院（出院标准组[DCG]）。

测量指标

记录人口统计学和出院变量，包括呼叫医生下达医嘱的时间、开具出院医嘱的时间以及实际出院时间。对各种出院变量的其他比较包括达到出院标准的时间、实际出院时间以及这些时间之间的差异。还比较了两组之间PACU住院时间超过60分钟的频率、PACU出院延迟情况以及达到出院标准的时间超过60分钟的情况。同时测量了楼层护士对患者状况的满意度以及记录的任何相关发病率。