Dynamics and Trends Around Clinical Events in the Postanesthesia Patient Within the First Twenty-four Hours: A Quality Improvement Project.

Abstract

Purpose: To explore the volume, types, severity, and timing of patient clinical events within the first 24 hours following anesthesia.

Design: A quality improvement project using purposive-sampled retrospective medical record reviews and database audits.

Methods: Data related to clinical events in postanesthesia patients seen by the rapid response nurse (RRN) in the postanesthesia care unit (PACU) within 24 hours of end anesthesia on the ward, between June 2022 and June 2023, were compiled and reviewed. Measurements captured included volume of events, clinical event types, surgical service, interventions, timing of the events after end anesthesia time, and patient disposition.

Findings: A total of 610 patients were noted as having a clinical event in the PACU and 333 postanesthesia patients had a RRN activation. On average, postanesthesia patients made up 10.7% of the total patients seen by the RRN and only 8.4% required transfer to the intensive care unit. Hypotension was the most common event type in the PACU, and the most common trigger for the RRN seeing postanesthesia patients within 24 hours. The majority (30.3%) triggered rapid response within 6 to 12 hours from end anesthesia time.

Conclusions: These results assist in shaping our nursing practice and education related to higher-acuity patients, rapid response team activation prevention, and identifying areas of current strength and further quality improvement. Discovering the keys to preventing hypotension, specifically in the postoperative period on the wards, will dramatically decrease rapid response team activations.