title: How well are prebooked surgical step-down units utilized?
abstract: OBJECTIVE
  To evaluate the utilization of the surgical step-down unit (SSDU) by a sample of patients who were preoperatively booked for admission to the unit, and to identify those patient characteristics and perioperative variables that are associated with an intervention in the unit.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Canadian tertiary-care facility.
  
  
  METHODS
  Data from 133 elective surgery patients with prebooked SSDU beds were recorded, including comorbidities, Surgical Risk Scale (SRS), Surgical Apgar Score (SAS), and number and nature of interventions and events occurring in the SSDU.
  
  
  RESULTS
  Of the 133 patients scheduled for SSDU admission, 60 (45.1%) were actually admitted and the other 73 (54.9%) were admitted directly to the surgical ward or else discharged. Of the patients admitted to the SSDU, 48.3% had an intervention during their stay. In logistic regression, the SRS was a significant predictor (P < 0.001) of SSDU use, while the SAS was a significant predictor (P = 0.034) of the need for an intervention or the likelihood of an event while in the SSDU.
  
  
  CONCLUSIONS
  Less than half of patients identified were actually admitted to the SSDU postoperatively; of those, less than half required an intervention. The Surgical Apgar Score, a score based on intraoperative factors, predicted the need for an intervention during SSDU admission. Consideration should be given to the development of a predictive score that emphasizes intraoperative factors and early postoperative factors to optimize allocation of this scarce resource.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON K7L 2V7, Canada.
authors.forename: Serena
authors.initials: S
authors.lastname: Shum
authors.forename: Rob
authors.initials: R
authors.lastname: Tanzola
authors.forename: Michael
authors.initials: M
authors.lastname: McMullen
authors.forename: Wilma M
authors.initials: WM
authors.lastname: Hopman
authors.forename: Dale
authors.initials: D
authors.lastname: Engen
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010343:Patient Admission; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods