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Effectiveness of the Semi-Automated Post-ANaesthesia Discharge Assessment Tool: A Pre-Post Study Using Propensity
Benjamin Albiez1,2, Jan Breckwoldt1, Julia Braun3
1Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Background:
Discharge management and workflow efficiency in a postanaesthesia care unit (PACU) can be improved with specific tools assessing discharge readiness. Several authors have found tools to reduce the PACU length of stay (PACU LOS), but results have remained inconsistent.
Aim:
We analysed the effects of the Post-ANaesthesia Discharge Assessment tool (PANDA) on PACU LOS, operating room (OR) holds, PACU nurses' confidence with the discharge decision and their perception of the tools' implementation.
Study Design:
This pre-post study with a propensity-matched historical control group evaluated the impact of the semi-automatic PANDA tool in a single primary-level hospital. The tool supports discharge decisions in the PACU. Median PACU LOS pre- and post-implementation was compared using nearest-neighbour propensity score matching and weighted linear regression. OR holds were analysed over 20 consecutive days. A structured nurse survey assessed confidence in discharge decisions and perceptions of the tool's implementation.
Results:
The study included 8475 patients (pre n = 4509; post n = 3966) and 19 nurses. Median PACU LOS before implementing the PANDA tool was 114 min (IQR 89-144) compared to 103 min (IQR 79-136) after the implementation. The weighted linear model showed an estimated difference in PACU LOS of -16 min (95% CI from -20 to -12 min, p < 0.001). There were too few OR holds for comparison. PACU nurses' confidence in their discharge decision remained unchanged before and after implementation. The PANDA tool received high ratings for acceptability, appropriateness, compatibility and feasibility.
Conclusion:
Implementing the semi-automated PANDA discharge tool significantly decreased PACU LOS. In addition, PACU nurses reported high acceptance, usefulness and feasibility of the tool. The PANDA discharge tool may optimise routine clinical practice to streamline PACU workflows, support resource allocation and decision-making and promote standardisation. Reducing PACU LOS may also improve patient flow and capacity planning in high-volume settings.
Relevance To Clinical Practice:
The semi-automated PANDA tool was well received by nurses who perceived it as useful and feasible. Given the significant reduction in PACU length of stay, integrating PANDA into clinical practice may enhance post-surgical patient flow and resource allocation, while its main added value lies in improving standardisation, supporting decision-making and PACU workflow.
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