Authors (including presenting author) :
Max HW Lau(1), Benny CP Cheng(1), Kenny KC Chan(2), Gladys WM Kwan(2)(3), Victor CH Cheung(1) , CW Lau(1), WK Ngan(1), Eric CW Kam(1), Jacky SK Yau(1), Renee PL Yip(1), Carmen KM Lam(1)
Affiliation :
(1) Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital; (2) Department of Intensive Care Unit, Tuen Mun Hospital; (3) Quality and Safety Division, Tuen Mun Hospital
Introduction :
Amid the COVID-19 pandemics, there was a rapid conversion of 2 ordinary PACU beds to provide extended post anaesthetic care (ePAC), aiming to alleviate the bed tight status in ICU and avoid OT cancellation due to ICU bed unavailability in TMH.
Objectives :
This study aims to evaluate the value- based effectiveness of the implementation of ePAC in terms of performance, effectiveness, and safety.
Methodology :
Multiple evaluation tools were implemented, including a descriptive statistics analysis, a quantitative caseload evaluation, a matched cohort study with a control-to-case ratio of 5, and a staff attitude survey based on the Technological Acceptance Model in healthcare.
Result & Outcome :
Result: 52 cases were admitted to ePAC, of which 70% came from ultra-major operations and 65.7% belonged to abdominal surgical cases. The estimated weekly cost reduction was $91,297. The overall 30-day mortality rate was 1.92% and the post-ePAC ICU admission rate was 9.61%. Matched cohort yielded ASA grading (p=0.027) and blood loss (p=0.003) predicted longer stays, whereas ePAC admission correlated with a lower incidence of high-level care beyond the first postoperative day. (p<0.001). Staff attitude survey unveiled overall favourable responses towards ePAC implementation during COVID, although 58.3% expressed unfavourably towards the ease of use, of which majority were junior nurses.
Conclusion: Our results showed that ePAC was a safe and cost-effective alternative to ICU admission for postoperative cases requiring level 2 intensive care, provided that the admission criteria for ePAC are clearly delineated and strictly followed. Training focusing on junior nursing staff would be essential prior to service commencement.
