title: Development and validation of the Efficacy Safety Score (ESS), a novel tool for postoperative patient management.
abstract: Several reports have shown that postoperative monitoring of general safety and quality issues, including pain treatment, after discharge from recovery is often non-systematic and inadequate. We suggest a new score with assessment of key recovery parameters, as a supportive tool for postoperative care and a call-out algorithm for need of extra help. The aim of this investigation was to validate the score.
  
  
  
  After suggesting a prototype score from a pilot study in 182 postoperative patients, we performed a Delphi process by using international experts to create consensus on the final score contents and called the revised tool the Efficacy Safety Score (ESS). Then, we performed a prospective observational study with the ESS throughout the first 24 h postoperatively in 207 surgical in-patients. We compared ESS with Modified Early Warning Systems (MEWS), and postoperative journal information. We subsequently validated ESS by addressing recognized quality criteria for measurement of health status questionnaires.
  
  
  
  A call-out value of ESS ≥10 correlated with MEWS > 0 values and journal information about postoperative concerns with a sensitivity of 94% and 92%, respectively. All serious safety issues were identified with the ESS ≥ 10, and a higher number of quality issues were identified than with routine care or MEWS. We obtained positive ratings for six out of seven tested criteria of questionnaire quality; one criterion had an indeterminate rating.
  
  
  
  ESS fulfils suggested criteria for score quality validation and reflects the patient's postoperative status adequately and with high sensitivity. Further clinical trials are warranted to evaluate the usefulness of ESS as a simple tool for assessment of the postoperative safety and quality of patients.
authors.affiliation: Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. erlend.skraastad@vestreviken.no.|Department of Anaesthesia and Intensive Care Medicine, Kongsberg Hospital, Vestre Viken HF, Drammensvn 4, 3612, Kongsberg, Norway. erlend.skraastad@vestreviken.no.
authors.forename: Erlend
authors.initials: E
authors.lastname: Skraastad
authors.affiliation: Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Johan
authors.initials: J
authors.lastname: Ræder
authors.affiliation: Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Anaesthesia and Intensive Care Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
authors.forename: Vegard
authors.initials: V
authors.lastname: Dahl
authors.affiliation: Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, University of Tromsø, 9037, Tromsø, Norway.
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Bjertnæs
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kuklin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist / Q000295:instrumentation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000295:instrumentation*; D061214:Patient Safety; D011184:Postoperative Period; D011446:Prospective Studies; D055815:Young Adult
keywords: Call-out algorithm; Checklist; Postoperative care; Postoperative nausea and vomiting; Postoperative pain