Skraastad Erlend, Ræder Johan, Dahl Vegard, Bjertnæs Lars J, Kuklin Vladimir
Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
Department of Anaesthesia and Intensive Care Medicine, Kongsberg Hospital, Vestre Viken HF, Drammensvn 4, 3612, Kongsberg, Norway.
BMC Anesthesiol. 2017 Mar 28;17(1):50. doi: 10.1186/s12871-017-0344-0.
Several reports have shown that postoperative monitoring of general safety and quality issues, including pain treatment, after discharge from recovery is often non-systematic and inadequate. We suggest a new score with assessment of key recovery parameters, as a supportive tool for postoperative care and a call-out algorithm for need of extra help. The aim of this investigation was to validate the score.
After suggesting a prototype score from a pilot study in 182 postoperative patients, we performed a Delphi process by using international experts to create consensus on the final score contents and called the revised tool the Efficacy Safety Score (ESS). Then, we performed a prospective observational study with the ESS throughout the first 24 h postoperatively in 207 surgical in-patients. We compared ESS with Modified Early Warning Systems (MEWS), and postoperative journal information. We subsequently validated ESS by addressing recognized quality criteria for measurement of health status questionnaires.
A call-out value of ESS ≥10 correlated with MEWS > 0 values and journal information about postoperative concerns with a sensitivity of 94% and 92%, respectively. All serious safety issues were identified with the ESS ≥ 10, and a higher number of quality issues were identified than with routine care or MEWS. We obtained positive ratings for six out of seven tested criteria of questionnaire quality; one criterion had an indeterminate rating.
ESS fulfils suggested criteria for score quality validation and reflects the patient's postoperative status adequately and with high sensitivity. Further clinical trials are warranted to evaluate the usefulness of ESS as a simple tool for assessment of the postoperative safety and quality of patients.
多项报告显示，术后恢复出院后对包括疼痛治疗在内的总体安全性和质量问题的监测往往缺乏系统性且不够充分。我们提出了一种新的评分方法，用于评估关键恢复参数，作为术后护理的辅助工具以及需要额外帮助的提醒算法。本研究的目的是验证该评分方法。
在对182例术后患者进行初步研究后提出了一个原型评分，然后我们通过国际专家进行了德尔菲法，就最终评分内容达成共识，并将修订后的工具称为疗效安全评分（ESS）。随后，我们对207例外科住院患者术后24小时全程使用ESS进行了前瞻性观察研究。我们将ESS与改良早期预警系统（MEWS）以及术后日志信息进行了比较。随后，我们通过满足公认的健康状况问卷测量质量标准来验证ESS。
ESS≥10的提醒值与MEWS>0的值以及术后相关问题的日志信息相关，敏感性分别为94%和92%。所有严重安全问题均通过ESS≥10被识别出来，并且识别出的质量问题数量比常规护理或MEWS更多。我们对问卷质量的七个测试标准中的六个获得了积极评价；一个标准的评价不确定。
ESS符合评分质量验证的建议标准，能够充分且高敏感性地反映患者的术后状态。有必要进行进一步的临床试验，以评估ESS作为评估患者术后安全性和质量的简单工具的实用性。
