title: Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis.
abstract: BACKGROUND
  While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the post-anaesthetic care unit (PACU). These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether the use of PACT will (1) enhance the recognition and response to patients at risk of deterioration in PACU; (2) improve documentation for handover from PACU nurse to ward nurse; (3) result in improved patient outcomes and (4) reduce healthcare costs.
  
  
  METHODS
  A prospective, non-randomised, pre-implementation and post-implementation design comparing: (1) patients (n=750) who have surgery prior to the implementation of the PACT and (2) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost-effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre-intervention and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as ORs with the corresponding 95% CIs.
  
  
  CONCLUSIONS
  This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce healthcare costs.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Eastern Health-Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia.
authors.forename: Maryann
authors.identifier: http://orcid.org/0000-0002-5615-141X
authors.initials: M
authors.lastname: Street
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Phillips
authors.affiliation: School of Nursing and Midwifery, Plymouth University, Plymouth, Devon, UK.
authors.forename: Bridie
authors.initials: B
authors.lastname: Kent
authors.affiliation: Department of Deakin Health Economics, Deakin University, Burwood, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Colgan
authors.affiliation: Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Mohebbi
mesh_terms: D000762:Anesthesia Recovery Period; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012306:Risk