Perret Laurelie, Buclin Clement P, Courvoisier Delphine S, Walder Bernhard
From the Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency (LP, BW), the Department of Medicine (CPB, DSC), the Division of Quality of Care (DSC), Geneva University Hospitals, Geneva, Switzerland.
Eur J Anaesthesiol Intensive Care. 2025 May 29;4(4):e0076. doi: 10.1097/EA9.0000000000000076. eCollection 2025 Aug.
Postoperative instruments supporting decision-making for optimal care level are lacking.
This study tested the reliability/validity of the postoperative track assessment tool (PoTra-tool) in a postanaesthesia care unit (PACU) and a specialised peri-operative intermediate care unit (IMCU).
A prospective observational study.
The PoTra-tool consists of two visual analog scales that rate estimated indication (VASi) and benefit (VASb) of care in an IMCU. The tool was tested on day 0 in both units of a Swiss university hospital, and on day 1 in the IMCU.
Raters were nurses with two levels of competency (noncertified or certified) and physicians with three levels of competency (noncertified, certified, consultant).
Reliability, between raters and across days, was assessed using intraclass correlation coefficients (ICCs) or weighted kappas. Validity was evaluated with validated scores (severity of illness, nurse workload and predicted mortality). Statistical analysis was carried out using analysis of variance (ANOVA) or Kruskal-Wallis tests.
In total, healthcare professionals performed 4206 ratings for 879 patients with a median [IQR] age of 72 [61 to 81] years) and for American Society of Anesthesiologists physical status scores 4 [4 to 4]. The median [IQR] VASi for PACU patients was 12 [2 to 30] and for IMCU patients, 76 [57 to 89]. Median VASb was 7 [1 to 19] for PACU patients and 66 [43 to 84] for IMCU patients. Internal consistency between VASi and VASb was high (Pearson correlation: 0.90). For each type of rater, reliability of VASi and VASb was acceptable to moderate for inter-rater reliability (weighted kappas: 0.59 to 0.67). The associations tested for construct validity were consistent with expected patterns, although the effect sizes were small.
The PoTra-tool may support the decision-making process in deciding the most appropriate peri-operative level of care for an individual patient: PACU with standard care or IMCU with specialised care.
ClinicalTrials.gov ID NCT05092867.
缺乏支持最佳护理水平决策的术后工具。
本研究在麻醉后护理单元（PACU）和专门的围手术期中间护理单元（IMCU）测试了术后追踪评估工具（PoTra工具）的可靠性/有效性。
一项前瞻性观察研究。
PoTra工具由两个视觉模拟量表组成，用于评估IMCU中护理的估计指征（VASi）和益处（VASb）。该工具在瑞士一家大学医院的两个科室的第0天进行了测试，并在IMCU的第1天进行了测试。
评分者为具有两种能力水平（未认证或认证）的护士和具有三种能力水平（未认证、认证、顾问）的医生。
使用组内相关系数（ICC）或加权kappa评估评分者之间以及不同日期之间的可靠性。使用经过验证的评分（疾病严重程度、护士工作量和预测死亡率）评估有效性。使用方差分析（ANOVA）或Kruskal-Wallis检验进行统计分析。
医疗保健专业人员总共对879名患者进行了4206次评分，患者年龄中位数为72岁[四分位间距61至81岁]，美国麻醉医师协会身体状况评分为4[4至4]。PACU患者的VASi中位数为12[2至30]，IMCU患者为76[57至89]。PACU患者的VASb中位数为7[1至19]，IMCU患者为66[43至84]。VASi和VASb之间的内部一致性较高（Pearson相关性：0.90）。对于每种类型的评分者，VASi和VASb的评分者间可靠性为可接受至中等（加权kappa：0.59至0.67）构建效度测试的关联与预期模式一致，尽管效应量较小。
PoTra工具可能有助于为个体患者决定最合适的围手术期护理水平提供决策支持：标准护理的PACU或专科护理的IMCU。
ClinicalTrials.gov标识符NCT05092867。
