Risk Management and Healthcare Policy (Nov 2020)
Perioperative Medical Emergencies in a 23-Hour Surgical Procedure Unit
Abstract
Joseph De Zylva, Kym Osborn Department of Anaesthesia, Lyell McEwin Hospital and Modbury Public Hospital, Northern Adelaide Local Health Network, Adelaide, South Australia, AustraliaCorrespondence: Joseph De ZylvaDepartment of Anaesthesia, Lyell McEwin Hospital and Modbury Public Hospital, Northern Adelaide Local Health Network, Haydown Road, Elizabeth Vale SA 5112, Adelaide, South Australia, AustraliaTel +61 8 8182 9806Fax +61 8 8182 9830Email [email protected]: Our 174-bed hospital operates a 23-hour/day procedure unit without a dedicated on-site high dependency unit or intensive care unit. The purpose of this investigation is to assess the incidence of medical emergency response (MER) and Code Blue (CB) events over 12 months.Patients and Methods: A retrospective analysis of hospital records was conducted. Patients were identified using the medical emergency team (MET) database. Information pertaining to whether the patient was pre-operative, post-operative (including time and characteristics of the operation), or medical short stay overflow was obtained, in addition to the reason for the MER/CB event and outcome of the event.Results: Of all hospital events, 8.45% (47 of 550) occurred in the perioperative ward. The incidence rate of events was 0.76% (95% CI: 0.53% to 0.99%) of all scheduled operations. The surgical procedure cancellation rate due to pre-operative MER/CB events was 0.11% (95% CI: 0.02% to 0.20%). Orthopedic surgery and ENT surgery were associated with the highest incidence of MER/CB events. Post-operative hypotension and reduced consciousness associated with vasovagal episodes were the most common clusters. The mean time after the operation for events to occur was 5.21 hours. 25.5% of events occurred outside of standard day surgery operating hours when there was limited access to onsite consultant anaesthetic or surgical staff (17:00 to 08:00).Conclusion: This study highlights the anticipated medical emergencies for a 23-hour procedural unit and is of particular interest for evaluation by other short stay surgical, outpatient procedural, or rural hospital surgical units with limited after hours on-site critical care support.Keywords: medical emergency response, critical care, perioperative, 23-hour surgical
