Determining criteria to assess patient readiness for discharge from postanaesthetic care: an international Delphi study

Authors

  • Nicole M Phillips PhD, MNS, GDipAdvNur, DipAppSc, BN, RN,

    Associate Professor & Director of Undergraduate Studies, Corresponding author
    1. School of Nursing and Midwifery, Deakin University, Burwood, Melbourne, Vic., Australia
    • Correspondence: Nicole M Phillips, Associate Professor & Director of Undergraduate Studies, School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, Vic. 3125, Australia. Telephone: +61 3 9251 7774. E-mail: nikki.phillips@deakin.edu.au

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  • Maryann Street BSc, PhD, Grad Dip Drug Eval & Pharm Sci,

    Research Fellow
    1. School of Nursing and Midwifery, Deakin University, Burwood, Melbourne, Vic., Australia
    2. Eastern Health – Deakin University Nursing & Midwifery Research Centre, Box Hill, Vic., Australia
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  • Bridie Kent BSc, PhD, RN,

    Professor in Leadership in Nursing
    1. Faculty of Health, Education and Society, School of Nursing and Midwifery, Plymouth University, Plymouth, UK
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  • Mary Cadeddu B Psych

    Research Fellow
    1. School of Nursing and Midwifery, Deakin University, Burwood, Melbourne, Vic., Australia
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Abstract

Aims and objectives

To obtain expert consensus on essential criteria required to assess patient readiness for discharge from the postanaesthetic care unit.

Background

A patient's condition can deteriorate after surgery, and the immediate postoperative period is recognised internationally as a time of increased risk to patient safety. A recent systematic review identified evidence-based assessment criteria for the safe discharge of patients from the postanaesthetic care unit and identified gaps in the evidence.

Design

Descriptive consensus study using the Delphi method.

Methods

Members of international clinical specialist groups with expertise in anaesthesia or postanaesthetic care participated in three consultation rounds. Online surveys were used to determine expert consensus with regard to aspects of postanaesthetic care and specific criteria for assessing patient readiness for discharge. Three rounds of surveys were conducted from May 2011–September 2012.

Results

Twenty-three experts contributed to the panel. Consensus, that is, at least 75% agreement, was reached in regard to 24 criteria considered essential (e.g. respiratory rate 100%; pain 100%; heart rate 95%; temperature 91%). Consensus was also reached for 15 criteria not considered essential (e.g. appetite 96%; headache 76%). Consensus was not obtained for a further 10 criteria. Participants (95%) agreed that a discharge tool was important to ensure safe patient discharge.

Conclusion

Consensus was achieved by a panel of international experts on the use of a tool to assess patient readiness for discharge from postanaesthesia care unit and specific variables to be included or excluded from the tool. Further work is required to develop a tool and test its reliability and validity.

Relevance to clinical practice

The findings of this study have informed the development of an evidence-based tool to be piloted in a subsequent funded study of nursing assessment of patient readiness for discharge from the postanaesthetic care unit.

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