title: A clinical pathway in a post-anaesthesia care unit to reduce length of stay, mortality and unplanned intensive care unit admission.
abstract: BACKGROUND
  The immediate post-operative period is critical with regard to post-operative outcomes.
  
  
  OBJECTIVE
  To assess the impact of a clinical pathway implemented in a post-anaesthesia care unit on post-operative outcomes.
  
  
  METHODS
  A retrospective cohort study based on electronic patient records.
  
  
  METHODS
  A post-anaesthesia care unit in a Swiss University Hospital.
  
  
  METHODS
  Adult patients after elective and non-elective surgery.
  
  
  METHODS
  Implementation of a clinical pathway with a nurse-driven fast-track programme for uncomplicated patients (systematic use of Aldrete score and systematic discharge without physician) and a physician-driven slow-track programme for complicated patients (systematic handover between operating theatre and post-anaesthesia care unit, and between post-anaesthesia care unit and ward, systematic rounds, systematic use of standardised care for post-operative events, strict discharge criteria).
  
  
  METHODS
  Post-anaesthesia care unit length of stay, in-hospital mortality and unplanned admission to the ICU after post-anaesthesia care unit stay.
  
  
  METHODS
  Comparison of the periods before and after implementation using median and interquartile range (IQR) and rates (%).
  
  
  METHODS
  unpaired Student's t-test, χ test, Wilcoxon rank test. Differences were adjusted through multivariate analyses with linear and logistic regression (level of significance: P < 0.05) and expressed as odds ratio (OR) with 95% confidence interval (95% CI).
  
  
  RESULTS
  After implementation, the median post-anaesthesia care unit length of stay decreased for all patients from 163 min (IQR 103-291) to 148 min (IQR 96-270; P < 0.001); in the American Society of Anaesthesiologists 1-2 patients, it decreased from 152 min (IQR 102-249) to 135 min (IQR 91-227; P < 0.001). In-hospital mortality decreased for all patients from 1.7 to 0.9% [adjusted OR 0.36 (95% CI 0.22-0.59), P < 0.001]. The number of unplanned admissions to the ICU decreased from 113 (2.8%) to 91 (2.1%) [adjusted OR 0.73 (95% CI 0.53-0.99), P = 0.04].
  
  
  CONCLUSIONS
  A clinical pathway in a post-anaesthesia care unit can significantly reduce length of stay and can improve post-operative outcome.
authors: Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland. alain-stephane.eichenberger@hcuge.ch
authors: Alain-S
authors: AS
authors: Eichenberger
authors: Guy
authors: G
authors: Haller
authors: Nicole
authors: N
authors: Cheseaux
authors: Vincent
authors: V
authors: Lechappe
authors: Philippe
authors: P
authors: Garnerin
authors: Bernhard
authors: B
authors: Walder
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D015331:Cohort Studies; D019091:Critical Pathways / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies