Systems and Criteria for Patient Evaluation and Discharge in the Post-Anesthesia Care Unit: A Systematic Review
Abstract
Safe transfer of patients who have undergone anesthesia and surgery is a basic principle to maintain stability, and avoid side effects and preventable errors. Specific scoring systems or criteria may be used to assess and decide whether patients are sufficiently recovered to be safely transferred to another ward or discharged home. This study aims to answer the question, what criteria are appropriate for patient evaluation and discharge in the post-anesthesia care unit? designed.
To find documents related to writing a review article on various scoring systems for patients after anesthesia in Google Scholar, PubMed, Scopus, and ScienceDirect databases and using English keywords post-anesthesia care unit, PACU, recovery room, discharge, scoring system, Assessment was searched.
A total of 168 articles were found by searching the databases. After removing duplicates, 77 articles were evaluated. Finally, 17 articles were selected and included in the study. The included studies included a variety of tools and criteria for evaluating and discharging patients in the post-anesthesia care unit. This article separately describes each of the tools and criteria for the evaluation and discharge of patients in the post-anesthesia care unit along with the method of scoring, advantages and disadvantages of each.
A safe scoring system for discharge from PACU should evaluate important parameters after anesthesia, including alertness, blood pressure, heart rate, ventilation, oxygen saturation, and surgical site bleeding, which can cause serious complications. Considering that one of the goals of PACU is to relieve patients’ pain in the post-surgery phase, the evaluation and control of pain and postoperative nausea and vomiting is effective in the satisfaction and safety of patients.
[1] Hatfield A. Foreword. The Complete Recovery Room Book: Oxford University Press; 2014. p. 0.
[2] Heydari F, Comprehensive recovery book, ed. 1. 1400, Tehran: Jame Negar.
[3] Steward DJ, Volgyesi G. Stabilometry: a new tool for the measurement of recovery following general anaesthesia for out-patients. Can Anaesth Soc J. 1978; 25(1):4-6.
[4] Rosen JE. Postoperative Care. In: Doherty GM, editor. Current Diagnosis & Treatment: Surgery, 15e. New York, NY: McGraw Hill LLC; 2020.
[5] Advani R, Stobbs NHW, Killick N, Kumar BN. @ Safe handover saves lives: results from clinical audit. Clinical Governance: An International Journal. 2015; 20:21-32.
[6] Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg. 1999; 88(3):508-17.
[7] McGrath B, Chung F. Postoperative recovery and discharge. Anesthesiol Clin North Am. 2003; 21(2):367-86.
[8] Truong L, Moran JL, Blum P. Post anaesthesia care unit discharge: a clinical scoring system versus traditional time-based criteria. Anaesth Intensive Care. 2004; 32(1):33-42.
[9] Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anaesth. 2006; 53(9):858-72.
[10] Brown I, Jellish WS, Kleinman B, Fluder E, Sawicki K, Katsaros J, et al. Use of postanesthesia discharge criteria to reduce discharge delays for inpatients in the postanesthesia care unit. J Clin Anesth. 2008; 20(3):175-9.
[11] Prates A, Colognese B, Caumo W, Stefani LC. Development of a recovery-room discharge checklist (SAMPE checklist) for safe handover and its comparison with Aldrete and White scoring systems. Braz J Anesthesiol. 2022; 72(2):200-206.
[12] Merchant R, Chartrand D, Dain S, Dobson G, Kurrek MM, Lagacé A, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2016. Can J Anaesth. 2016; 63(1):86-112.
[13] Scott AM, Li J, Oyewole-Eletu S, Nguyen HQ, Gass B, Hirschman KB, et al. Understanding Facilitators and Barriers to Care Transitions: Insights from Project ACHIEVE Site Visits. Jt Comm J Qual Patient Saf. 2017; 43(9):433-47.
[14] Phillips NM, Street M, Kent B, Haesler E, Cadeddu M. Post-anaesthetic discharge scoring criteria: key findings from a systematic review. Int J Evid Based Healthc. 2013;11(4):275-84.
[15] Vickers MD. THE MEASUREMENT OF RECOVERY FROM ANAESTHESIA. Br J Anaesth. 1965; 37:296-302.
[16] Newman MG, Trieger N, Miller JC. Measuring recovery from anesthesia--a simple test. Anesth Analg. 1969; 48(1):136-40.
[17] Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970; 49(6):924-34.
[18] Fraulini KE, Murphy P. R.E.A.C.T. A new system for measuring postanesthesia recovery. Nursing. 1984; 14(4):101-2.
[19] Stephenson E. Discharge criteria in day surgery. J Adv Nurs. 1990;15(5):601-13.
[20] Quinn CL, Weaver JM, Beck M. Evaluation of a clinical recovery score after general anesthesia. Anesth Prog. 1993; 40(3):67-71.
[21] Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth. 1995; 7(6):500-6.
[22] Lubarsky DA. Fast track in the postanesthesia care unit: unlimited possibilities? J Clin Anesth. 1996; 8(3 Suppl):70s-2s.
[23] Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998; 13(3):148-55.
[24] Nicola C. Visual analogue scale(VAS). J clin nurs. 2001; 10(5).
[25] Saar LM. Use of a modified Postanesthesia Recovery Score in phase II perianesthesia period of ambulatory surgery patients. J Perianesth Nurs. 2001; 16(2):82-9.
[26] Gärtner R, Callesen T, Kroman N, Kehlet H. Recovery at the post anaesthetic care unit after breast cancer surgery. Dan Med Bull. 2010; 57(2):A4137.
[27] Pazar B, Yava A. Evaluation of Early Warning Scoring System and Nursing Guide Application in Post-Anaesthesia Care Unit. Turk J Anaesthesiol Reanim. 2013; 41(6):216-22.
[28] Ecoff L, Palomo J, Stichler JF. Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool. J Perianesth Nurs. 2017; 32(5):389-99.
[29] Whitley DR, Crow PH, Gore PC, Gregory VK, Pfeiffer KG, Taylor YJ. Discerning Post Anesthesia Readiness for Transition (DPART): A Measurement Tool. J Perianesth Nurs. 2020; 35(2):160-70.
[30] Prates A, Colognese B, Caumo W, Stefani LC. Development of a recovery-room discharge checklist (SAMPE checklist) for safe handover and its comparison with Aldrete and White scoring systems. Braz J Anesthesiol. 2022; 72(2):200-6.
[31] Phillips NM, Haesler E, Street M, Kent B. Post-anaesthetic discharge scoring criteria: A systematic review. JBI Libr Syst Rev. 2011; 9(41):1679-713.
[32] Apfelbaum JL, Silverstein JH, Chung FF, Connis RT, Fillmore RB, Hunt SE, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013; 118(2):291-307.
[33] Kulkarni S, Harsoor SS, Chandrasekar M, Bhaskar SB, Bapat J, Ramdas EK, et al. Consensus statement on anaesthesia for day care surgeries. Indian J Anaesth. 2017; 61(2):110-24.
[34] White PF. Criteria for fast-tracking outpatients after ambulatory surgery. J Clin Anesth. 1999; 11(1):78-9.
[35] White PF, Song D. New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system. Anesth Analg. 1999; 88(5):1069-72.
[36] Fredman B, Sheffer O, Zohar E, Paruta I, Richter S, Jedeikin R, et al. Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures. Anesth Analg. 2002; 94(3):560-4.
[37] Song D, van Vlymen J, White PF. Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane? Anesth Analg. 1998; 87(6):1245-8.
[38] Dowling LP. Aldrete Discharge Scoring: Appropriate for Post Anesthesia Phase I Discharge? 2015.
[39] Street M, Phillips NM, Kent B, Colgan S, Mohebbi M. Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis. BMJ open. 2015; 5(6):e007200.
[40] Ecoff L, Palomo J, Stichler JF. Design and testing of a postanesthesia care unit readiness for discharge assessment tool J Perianesth Nurs. 2017;32(5):389-99.
[41] Hawker RJ, McKillop A, Jacobs S. Postanesthesia scoring methods: An integrative review of the literature. J Perianesth Nurs. 2017; 32(6):557-72.
[42] Banerjee S, Kohli P, Pandey M. A study of modified Aldrete score and fast-track criteria for assessing recovery from general anaesthesia after laparoscopic surgery in Indian adults. Perioperative Care and Operating Room Management. 2018; 12:39-44.
[2] Heydari F, Comprehensive recovery book, ed. 1. 1400, Tehran: Jame Negar.
[3] Steward DJ, Volgyesi G. Stabilometry: a new tool for the measurement of recovery following general anaesthesia for out-patients. Can Anaesth Soc J. 1978; 25(1):4-6.
[4] Rosen JE. Postoperative Care. In: Doherty GM, editor. Current Diagnosis & Treatment: Surgery, 15e. New York, NY: McGraw Hill LLC; 2020.
[5] Advani R, Stobbs NHW, Killick N, Kumar BN. @ Safe handover saves lives: results from clinical audit. Clinical Governance: An International Journal. 2015; 20:21-32.
[6] Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg. 1999; 88(3):508-17.
[7] McGrath B, Chung F. Postoperative recovery and discharge. Anesthesiol Clin North Am. 2003; 21(2):367-86.
[8] Truong L, Moran JL, Blum P. Post anaesthesia care unit discharge: a clinical scoring system versus traditional time-based criteria. Anaesth Intensive Care. 2004; 32(1):33-42.
[9] Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anaesth. 2006; 53(9):858-72.
[10] Brown I, Jellish WS, Kleinman B, Fluder E, Sawicki K, Katsaros J, et al. Use of postanesthesia discharge criteria to reduce discharge delays for inpatients in the postanesthesia care unit. J Clin Anesth. 2008; 20(3):175-9.
[11] Prates A, Colognese B, Caumo W, Stefani LC. Development of a recovery-room discharge checklist (SAMPE checklist) for safe handover and its comparison with Aldrete and White scoring systems. Braz J Anesthesiol. 2022; 72(2):200-206.
[12] Merchant R, Chartrand D, Dain S, Dobson G, Kurrek MM, Lagacé A, et al. Guidelines to the Practice of Anesthesia - Revised Edition 2016. Can J Anaesth. 2016; 63(1):86-112.
[13] Scott AM, Li J, Oyewole-Eletu S, Nguyen HQ, Gass B, Hirschman KB, et al. Understanding Facilitators and Barriers to Care Transitions: Insights from Project ACHIEVE Site Visits. Jt Comm J Qual Patient Saf. 2017; 43(9):433-47.
[14] Phillips NM, Street M, Kent B, Haesler E, Cadeddu M. Post-anaesthetic discharge scoring criteria: key findings from a systematic review. Int J Evid Based Healthc. 2013;11(4):275-84.
[15] Vickers MD. THE MEASUREMENT OF RECOVERY FROM ANAESTHESIA. Br J Anaesth. 1965; 37:296-302.
[16] Newman MG, Trieger N, Miller JC. Measuring recovery from anesthesia--a simple test. Anesth Analg. 1969; 48(1):136-40.
[17] Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970; 49(6):924-34.
[18] Fraulini KE, Murphy P. R.E.A.C.T. A new system for measuring postanesthesia recovery. Nursing. 1984; 14(4):101-2.
[19] Stephenson E. Discharge criteria in day surgery. J Adv Nurs. 1990;15(5):601-13.
[20] Quinn CL, Weaver JM, Beck M. Evaluation of a clinical recovery score after general anesthesia. Anesth Prog. 1993; 40(3):67-71.
[21] Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth. 1995; 7(6):500-6.
[22] Lubarsky DA. Fast track in the postanesthesia care unit: unlimited possibilities? J Clin Anesth. 1996; 8(3 Suppl):70s-2s.
[23] Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998; 13(3):148-55.
[24] Nicola C. Visual analogue scale(VAS). J clin nurs. 2001; 10(5).
[25] Saar LM. Use of a modified Postanesthesia Recovery Score in phase II perianesthesia period of ambulatory surgery patients. J Perianesth Nurs. 2001; 16(2):82-9.
[26] Gärtner R, Callesen T, Kroman N, Kehlet H. Recovery at the post anaesthetic care unit after breast cancer surgery. Dan Med Bull. 2010; 57(2):A4137.
[27] Pazar B, Yava A. Evaluation of Early Warning Scoring System and Nursing Guide Application in Post-Anaesthesia Care Unit. Turk J Anaesthesiol Reanim. 2013; 41(6):216-22.
[28] Ecoff L, Palomo J, Stichler JF. Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool. J Perianesth Nurs. 2017; 32(5):389-99.
[29] Whitley DR, Crow PH, Gore PC, Gregory VK, Pfeiffer KG, Taylor YJ. Discerning Post Anesthesia Readiness for Transition (DPART): A Measurement Tool. J Perianesth Nurs. 2020; 35(2):160-70.
[30] Prates A, Colognese B, Caumo W, Stefani LC. Development of a recovery-room discharge checklist (SAMPE checklist) for safe handover and its comparison with Aldrete and White scoring systems. Braz J Anesthesiol. 2022; 72(2):200-6.
[31] Phillips NM, Haesler E, Street M, Kent B. Post-anaesthetic discharge scoring criteria: A systematic review. JBI Libr Syst Rev. 2011; 9(41):1679-713.
[32] Apfelbaum JL, Silverstein JH, Chung FF, Connis RT, Fillmore RB, Hunt SE, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013; 118(2):291-307.
[33] Kulkarni S, Harsoor SS, Chandrasekar M, Bhaskar SB, Bapat J, Ramdas EK, et al. Consensus statement on anaesthesia for day care surgeries. Indian J Anaesth. 2017; 61(2):110-24.
[34] White PF. Criteria for fast-tracking outpatients after ambulatory surgery. J Clin Anesth. 1999; 11(1):78-9.
[35] White PF, Song D. New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete's scoring system. Anesth Analg. 1999; 88(5):1069-72.
[36] Fredman B, Sheffer O, Zohar E, Paruta I, Richter S, Jedeikin R, et al. Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures. Anesth Analg. 2002; 94(3):560-4.
[37] Song D, van Vlymen J, White PF. Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane? Anesth Analg. 1998; 87(6):1245-8.
[38] Dowling LP. Aldrete Discharge Scoring: Appropriate for Post Anesthesia Phase I Discharge? 2015.
[39] Street M, Phillips NM, Kent B, Colgan S, Mohebbi M. Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis. BMJ open. 2015; 5(6):e007200.
[40] Ecoff L, Palomo J, Stichler JF. Design and testing of a postanesthesia care unit readiness for discharge assessment tool J Perianesth Nurs. 2017;32(5):389-99.
[41] Hawker RJ, McKillop A, Jacobs S. Postanesthesia scoring methods: An integrative review of the literature. J Perianesth Nurs. 2017; 32(6):557-72.
[42] Banerjee S, Kohli P, Pandey M. A study of modified Aldrete score and fast-track criteria for assessing recovery from general anaesthesia after laparoscopic surgery in Indian adults. Perioperative Care and Operating Room Management. 2018; 12:39-44.
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How to Cite
1.
Saei A, Taghizadeh S, Azizi Darbandi MM, Gholamzadeh M. Systems and Criteria for Patient Evaluation and Discharge in the Post-Anesthesia Care Unit: A Systematic Review. Arch Anesth & Crit Care. 2024;.
