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Development and Evaluation of the Pediatric Readiness for Discharge (P-REDI) Tool
Stephanie Grasso1, Lee-Anne Waterman2, Emily Parra2
1UNC Spine Center, Department of Physical Medicine and Rehabilitation, University of North Carolina Health, Chapel Hill, NC.
Insights
The P-REDI discharge tool improved nurses' comfort and reduced Phase II PACU time for ambulatory surgery patients without increasing adverse events. This safe discharge tool enhances patient care efficiency.
Area of Science:
- Anesthesiology
- Nursing
- Healthcare Management
Background:
- Safe patient discharge from the Postanesthesia Care Unit (PACU) is critical for ambulatory surgery outcomes.
- Existing discharge protocols may lack objectivity, impacting nurse confidence and efficiency.
- The P-REDI tool was developed to address these challenges through literature review and expert collaboration.
Purpose of the Study:
- To evaluate the effectiveness of the P-REDI discharge tool for safe patient discharge home after ambulatory surgery.
- To assess the impact of the P-REDI tool on key patient safety and efficiency metrics.
Main Methods:
- A quasi-experimental, mixed-methods design was employed, incorporating pre/post nurse surveys and retrospective chart reviews.
- Data were collected before, during, and after P-REDI implementation, analyzing unscheduled clinic visits, ED visits, readmissions, and length of stay.
- Statistical analyses included descriptive statistics, bivariate statistics, and correlations using electronic health record data.
Main Results:
- Nurses reported improved perceptions of discharge criteria following P-REDI implementation.
- No significant differences in adverse events were observed across implementation phases.
- A significant decrease in Phase II PACU length of stay was noted post-implementation.
- P-REDI scores correlated significantly with procedure length and overall length of stay.
Conclusions:
- The P-REDI tool provides nurses with an objective measure to enhance confidence in discharging patients from Phase II PACU.
- Implementation of the P-REDI tool significantly reduced Phase II PACU length of stay without compromising patient safety.
- Future research should explore the cost-effectiveness of the P-REDI tool for healthcare institutions.
Purpose:
The purpose of this study was to evaluate the P-REDI discharge tool for safe discharge to home following ambulatory surgery.
Design:
A quasi-experimental, mixed methods with pre/post nurse surveys and retrospective chart review comparing pre-, interim- and post-implementation of P-REDI on unscheduled clinic visits, Emergency Department visits, hospital readmission, and length of stay.
Methods:
The P-REDI tool was developed in collaboration with anesthesia and based upon an extensive review of the literature on safe discharge from the Phase II Postanesthesia Care Unit (PACU). Nurse surveys and patient data extracted from the electronic health record through the computer-assisted reporting system were analyzed using descriptive statistics, bivariate statistics, and correlations to assess outcomes and relationships between variables.
Findings:
Nurses' perceptions of discharge criteria improved after implementation of P-REDI. There were no differences in adverse events before, during, and after the implementation of the P-REDI instrument. There was a significant decrease in Phase II time after implementation of the tool. There were also significant correlations with the P-REDI score and related variables such as length of surgical procedure time and length of stay.
Conclusions:
The P-REDI tool was developed to provide nurses a concrete, objective tool to increase their level of comfort with discharging patients from the Phase II PACU. The tool significantly decreased length of stay in Phase II without any change in adverse events. The cost savings to the institution needs to be examined in future studies.
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