title: Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital.
abstract: We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and assessed the effect of these incidents on PACU length of stay and discharge disposition.
  
  
  
  A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents was recorded in the administrative database using a standardised data form.
  
  
  
  There were 701 incidents involving 364 patients; 203 (55.8%) patients had American Society of Anesthesiologists (ASA) physical status I or II. The most common critical incidents were cardiovascular-related (n = 293, 41.8%), respiratory (n = 155, 22.1%), neurological (n = 52, 7.4%), surgical (n = 47, 6.7%) and airway-related (n = 34, 4.9%). There were two incidents of cardiac arrest and 25 incidents of unexpected reintubations. Many patients (n = 186, 51.2%) stayed for over four hours in the PACU due to critical incidents and 184 (50.5%) patients required a higher level of care postoperatively than initially planned. Some patients (n = 34, 9.3%) returned to the operation theatre for further management. A proportion of patients (n = 64, 17.6%) had unplanned intensive care unit admissions due to adverse events in the PACU.
  
  
  
  A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilisation and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated.
authors.affiliation: Department of Anaesthesia, Singapore General Hospital, Singapore.
authors.forename: Suze Dominique
authors.initials: SD
authors.lastname: Bruins
authors.affiliation: Specialty Nursing, Nursing Division, Singapore General Hospital, Singapore.
authors.forename: Pauline Meng Choo
authors.initials: PM
authors.lastname: Leong
authors.affiliation: Department of Anaesthesia, Singapore General Hospital, Singapore.
authors.forename: Shin Yi
authors.initials: SY
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge; D011182:Postoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data; D011997:Recovery Room / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: critical incidents; length of stay; post-anaesthesia care unit; postoperative care; recovery room