Measuring Recovery
Recovery of a patient after uncomplicated anesthesia and surgery
is often routine. Many studies of recovery room care compare intermediate end points
such as early awakening or return to baseline on psychometric tests.
Figure 71-14
Postanesthesia care unit (PACU) simulation model for
nursing staffing. The simulations assume that the surgery suite determines the number
of full-time equivalents to staff the PACU by scheduling the minimum number to handle
the peak workload on 95% of days. Full-time nurses are scheduled on overlapping
shifts (two shifts per day) so that all nurses are present at the time of day when
the peak number of patients in the PACU is expected.
A patient-rated quality-of-recovery score with good validity, reliability, and clinical
acceptability in outpatients undergoing many types of surgery has been developed.
[202]
This instrument focused on patients' assessments
of what constitutes a favorable anesthetic and outcome. The authors suggest that
this tool be used as an outcome measure in clinical studies and that approximately
20 patients would be required in each group to detect a significant difference in
recovery. For patients undergoing minor surgery, this instrument yielded an average
quality-of-recovery score of 18 preoperatively, 15 during PACU recovery, 16 at 4
hours after surgery, 17 from day 1 to day 5 postoperatively, and 18 after week 1.
For major surgery, the average scores were 18 preoperatively, 13 during PACU recovery,
14 after 4 hours following completion of surgery, 15 on
TABLE 71-6 -- Number of full-time PACU nurses needed to be employed each day when admissions
are from 7:00 AM to 4:00 PM
|
|
|
Number of Full-Time Nurses
Required per Day by Phase 1 Bypass Rate |
|
Time in Phase 1 (min) |
Time in Phase 2 (min) |
Mean Number of Patients Each
Day |
0% |
20% |
40% |
60% |
80% |
|
30 |
60 |
20 |
6 |
5 |
5 |
5 |
4 |
|
30 |
60 |
30 |
7 |
7 |
7 |
6 |
6 |
|
30 |
60 |
40 |
9 |
9 |
8 |
7 |
7 |
|
60 |
60 |
20 |
7 |
7 |
6 |
5 |
5 |
|
60 |
60 |
30 |
9 |
8 |
8 |
7 |
6 |
|
60 |
60 |
40 |
11 |
10 |
9 |
8 |
7 |
|
60 |
120 |
20 |
8 |
8 |
7 |
6 |
6 |
|
60 |
120 |
30 |
11 |
10 |
9 |
9 |
8 |
|
60 |
120 |
40 |
14 |
13 |
12 |
11 |
10 |
|
Adapted from Dexter F, Macario A, Manberg P, Lubarsky
D: Computer simulation to determine how rapid anesthetic recovery protocols affect
staffing of an ambulatory surgery center. Anesth Analg 88:1053, 1999. |
postoperative day 1, 16 on day 2, 17 on day 3, and normalized to 18 after 2 weeks.
