A preoperative scoring system to identify patients requiring postoperative high dependency care

The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring.

A nursing preoperative assessment tool was developed to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU.

All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool.

During the time period studied, acute admissions to ICU/HDU reduced from 40.37 to 19.11%.

Only 24.04% of patients who had a PAS >4 were identified by the surgeon and/or anesthetist as being at risk of a postoperative complication, or if identified, no provision was made for improved postoperative monitoring. This supports the need for nurses to be involved in identifying preoperatively patients at risk of a postoperative complication and in need of improved postoperative monitoring. The postoperative monitoring requirements for the PAS >4 patients were relatively low technology interventions.

The preoperative assessment tool is a simple and effective tool for nurses to identify patients at risk of postoperative complications and reduces the number of acute admissions to ICU/HDU.