Treating cardiac surgery emergencies: the role of the noncardiac anaesthetist in the first 30 min

Abstract

In case of nonavailability of a protocol, the physician on duty was responsible for the individual decision to discharge the patient in 32 out of 34 hospitals. In 6 of 34, the nurse was (also) in charge of discharging the patient.Questions regarding length of stay were subdivided for normal-risk and high-risk patients. Normal risk was defined as ASA 1 to 2 and type 1 to 2 surgery, and high-risk was defined as ASA 3 or higher undergoing all types of surgery. Interestingly, hospitals with a discharge protocol had a higher proportion of normal-risk patients staying only 0 to 2 h at the PACU (66 vs. 44%), and a smaller proportion of patients staying 8 to 24 h (10 vs. 21%). In high-risk patients, this pattern was less visible.Regardless of current use of a postoperative discharge protocol (including existing scores like Aldrete), the majority of respondents (70 hospitals, 69%) indicated that there was a need for development of a discharge score. The main reported reasons were patient safety (67/70) and better planning and logistics (43/70). Large hospitals more often reported the need for such a score (77% in large vs. 58% in small hospitals).To summarise, this survey demonstrated a wide variation in the organisation of postoperative care in European hospitals. We observed differences in staffing on the PACU, as well as treatment options offered and discharge practices. The effect of heterogeneous practices on quality of care is largely unknown. Therefore, a European study on postoperative care pathways and outcomes is a future priority.Furthermore, the results of our survey underline the perceived need for development of a postoperative discharge score that might include an adaptation of existing scores, such as Aldrete, into a more complex protocol suitable for both low-risk and high-risk patients. 2 We need to optimise care pathways for our patients, and a robust PACU concept might help us to overcome the shortage of ICU beds without a reduction in quality of care.