Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital

Bruins, Suze; Leong, Pauline Meng Choo; Ng, Shin Yi

doi:10.11622/smedj.2016126

Cited by 29 publications

(40 citation statements)

References 14 publications

(18 reference statements)

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“…The length of stay in PACU greater than 4 hours (AOR=4.538;95% CI (2.089 -9.857) were strongly correlated with the incidence of PACU complication, our study also observed that patients who encountered PACU complications signi cantly required a prolonged duration of stay than initially planned compared to patients without complications (9,22).…”

Section: Discussionsupporting

confidence: 66%

Incidence and Factors Associated With Post-anesthesia Care Unit Complications at St. Paul’s Hospital, Ethiopia. Observational Study

Abebe

Kifle

Gunta

et al. 2022

Preprint

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Background: Postoperative complications are frequent encounters in the patients admitted to post-anesthesia care units (PACU). The main aim of this study was to assess the incidence and associated factors of complications among surgical patients admitted to PACU.Methods: This is an observational study of 396 surgical patients admitted to PACU. This study was conducted from February 1 to March 30, 2021, in Ethiopia. Study participant's demographics, anesthesia, and surgery-related parameters, PACU complications, and length of stay in PACU were documented. Multivariate and bivariate logistic regression analyses, the odds ratio (OR), and 95% confidence interval (CI) were calculated. P-value < 0.05 was considered as statistically significant.Results: The incidence of complications among surgical patients admitted to PACU was 54.8%. Of these, respiratory-related complications and postoperative nausea/vomiting were the most common types of PACU complications. Being a female (AOR=2.928;95%CI:(1.899-4.512)) was significantly associated with an increased risk of developing PACU complications. Duration of anesthesia >4 hours (AOR=5.406; 95% CI (2.418_12.088) revealed an increased risk of association with PACU complications. The occurrences of intraoperative complications (AOR=2.238; 95% CI (0.991_5.056) during surgery were also associated with PACU complications. Patients who develop PACU complications were strongly associated with length of PACU stay for > 4 hours (AOR=2.177; 95% CI (0 .741_ 6.401)).Conclusion: The identified risk factors for complications in surgical patients admitted to PACU are female sex, longer duration of anesthesia, and intraoperative complications occurrences. Patients who developed complications had a long time of stay in PACU.

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Section: Discussionsupporting

confidence: 66%

Incidence and Factors Associated With Post-anesthesia Care Unit Complications at St. Paul’s Hospital, Ethiopia. Observational Study

Abebe

Kifle

Gunta

et al. 2022

Preprint

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“…An institution-based prospective follow up study was conducted from April 20, 2021 to June 28, 2021 to determine the incidence and predictive factors of hemodynamic instability in the post anesthesia care unit of a comprehensive specialized referral hospital in Ethiopia. This paper was registered in research registry with unique identifying number [ 23 ] of 7543 and was guided by STROCSS 2021 checklist [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Incidence and predictive factors associated with hemodynamic instability among adult surgical patients in the post-anesthesia care unit, 2021: A prospective follow up study

Abebe

Arefayne

Temesgen

et al. 2022

Annals of Medicine &Amp; Surgery

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Background Hemodynamic instability, which is an independent predictor of long-term patient morbidity and duration of stay in the hospital, is a risk for patients in the post-anesthesia care unit. Multiple factors contribute to the development of postoperative hemodynamic instability. Prevention and treatment of these factors may reduce patients' hemodynamic instability, and its associated morbidity and mortality. Objective The aim of this study was to determine the incidence and factors associated with hemodynamic instability among adult surgical patients in the post-anesthesia care unit. Method An institution-based prospective follow up study was conducted from April 20, 2021 to June 28, 2021. Four hundred and seventeen (417) adult surgical patients were involved in this study. Descriptive and analytic statistics were used to describe our results. Both the bivariable and multivariable logistic regression with crude odds ratio and adjusted odds ratio were used with a 95% confidence interval to evaluate the strength of association. In multivariable regression, a p-value < 0.05 was considered as statistically significant. Result The overall incidence of hemodynamic instability was 59.47% (CI: 0.55, 0.64). The incidence of tachycardia, bradycardia, hypotension, and hypertension were 27.34%, 21.82%, 13.67%, and 15.35% respectively. Preoperative use of beta-blockers, ASA class III, procedure longer than 4 h, intraoperative hemodynamic instability, and regional anesthesia were significantly associated with hemodynamic instability in the post-anesthesia care unit. Conclusion and recommendation The incidence of hemodynamic instability in the post anesthesia care unit was high. Preoperative use of beta-blockers, intraoperative hemodynamic instability, and prolonged duration of procedures were predictors of hemodynamic instability after operation. Early detection and management of these perioperative risk factors is necessary to reduce hemodynamic instability in the post-anesthesia care unit.

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“…Although this preoccupation with failure is a key principle of HRO, it is often ignored in healthcare [ 8 ]. Retrospective reviews and incident reports have highlighted how healthcare staff often assumes that what is in front of them is correct and do not approach tasks with a mindset to look for potential errors [ 9–12 ].…”

Section: Introductionmentioning

confidence: 99%

Learning from safety incidents in high-reliability organizations: a systematic review of learning tools that could be adapted and used in healthcare

Serou

Sahota

Husband

et al. 2021

International Journal for Quality in Health Care

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Background A high reliability organization is an organization that has sustained almost error-free performance, despite operating in hazardous conditions where the consequences of errors could be catastrophic. A number of tools and initiatives have been used within High Reliability Organizations to learn from safety incidents, some of which have the potential to be adapted and used in health care. We conducted a systematic review to identify any learning tools deemed to be effective that could be adapted and used by multidisciplinary teams in healthcare following a patient safety incident. Methods This review followed the PRISMA-P reporting guidelines and was registered with the PROSPERO (CRD42017071528). A search of databases was carried out in January 2021, from the date of their commencement. Electronic databases include Web of Science, Science Direct, MEDLINE in Process Jan 1950-present, EMBASE Jan 1974-present, CINAHL 1982-present, PsycINFO 1967-present, Scopus and Google Scholar. We also searched the grey literature including reports from government agencies, relevant doctoral dissertations and conference proceedings. A customised data extraction form was used to capture pertinent information from included studies and Critical Appraisal Skills Programme tool to appraise on their quality. Results A total of 5,921 articles were identified, with 964 duplicate articles removed and 4932 excluded at the title (4055), abstract (510) and full text (367) stages. Twenty-five articles were included in the review. Learning tools identified included debriefing, simulation, Crew Resource Management and reporting systems to disseminate safety messages. Debriefing involved deconstructing incidents using reflective questions, whilst simulation training involved asking staff to relive the event again by performing the task(s) in a role-play scenario. Crew resource management is a set of training procedures that focus on communication, leadership, and decision making. Sophisticated Incident reporting systems provide valuable information on hazards and were widely recommended as a way of disseminating key safety messages following safety incidents. These learning tools were found to have a positive impact on learning if conducted soon after the incident with efficient facilitation. Conclusion Healthcare organizations should find ways to adapt the learning tools or initiatives used in high reliability organizations following safety incidents. It is challenging to recommend any specific one as all learning tools have shown considerable promise. However, the way these tools or initiatives are implemented is critical and so further work is needed to explore how to successfully embed them into health care organizations so that everyone at every level of the organization embraces them.

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Retrospective review of critical incidents in the post-anaesthesia care unit at a major tertiary hospital

Cited by 29 publications

References 14 publications

Incidence and Factors Associated With Post-anesthesia Care Unit Complications at St. Paul’s Hospital, Ethiopia. Observational Study

Incidence and Factors Associated With Post-anesthesia Care Unit Complications at St. Paul’s Hospital, Ethiopia. Observational Study

Incidence and predictive factors associated with hemodynamic instability among adult surgical patients in the post-anesthesia care unit, 2021: A prospective follow up study

Learning from safety incidents in high-reliability organizations: a systematic review of learning tools that could be adapted and used in healthcare

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