Development and Psychometric Testing of a Post-Anesthesia Care Unit Discharge Scoring System

Monday, 22 July 2013: 11:25 AM

Laurie Ecoff, PhD, RN, NEA-BC1
Jeanne Palomo, BSN2
Kristen Vacinek, BSN2
Jaynelle F. Stichler, DNS, RN, NEA-BC, FACHE, FAAN3
(1)Nursing, Sharp Memorial Hospital, San Diego, CA
(2)Post Anesthesia Care Unit, Sharp Memorial Hospital, San Diego, CA
(3)School of Nursing, San Diego State University, San Diego, CA

Learning Objective 1: The learner will be able to describe a systematic process to evaluate practice and determine opportunities for improvement.

Learning Objective 2: The learner will be able to discuss the steps in developing and psychometrically testing a PACU discharge scoring system.

Purpose: Accurate assessment of the patient’s status post-operatively is critical prior to discharge from the Post Anesthesia Care Unit (PACU) to a nursing unit. The current discharge scoring system did not accurately predict readiness for discharge from the PACU. The purpose of the study was to develop and psychometrically test a PACU discharge scoring system.

Methods: A literature search was conducted for a reliable and valid PACU discharge scoring system. Although several systems were found, no system contained all criteria important for a safe discharge. Gaps included pain, nausea, hypertension, oxygenation, temperature, and resolution of spinal anesthesia. A query of Magnet organizations revealed similar gaps in discharge systems and an interest in the development of a comprehensive, valid and reliable system.

A 10-item tool was developed from other published tools and recommendations for discharge criteria described by the American Society of Anesthesiologists and the American Society of Peri-Anesthesia Nurses. Experts in the PACU setting including nurses and anesthesiologists established content and face validity. Reliability testing of the tool was conducted by scoring patients on both the existing and the new 10-item tool and then comparing readiness for discharge. Additionally, two PACU nurses scored the new system to determine inter-rater reliability and differences in PACU length of stay between the existing and study tool were compared.

Results: The content validity index for the list of discharge assessment items and the accompanying criteria was .80. There was 100% agreement among PACU nurses for 202 patients scored using the scoring tool. There was a mean difference of 27 minutes between the discharge times using the existing system as compared to the new tool; however, the difference was not statistically significant.

Conclusion: Development and psychometric testing of a valid and reliable discharge scoring system ensures that patients are discharge safely from the PACU setting.