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Measures of Quality of Recovery and Discharge-readiness Tools in the Pediatric Postanesthesia Care Unit
Issada Jindawatthana1, Cameron Graydon2, Paul Lee-Archer3
1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Anaesthesia Research, Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Pediatric postanesthesia care unit (PACU) assessments often miss children's recovery experiences. Current tools need improvement to better capture key recovery domains for children, families, and clinicians.
Area of Science:
- Pediatric Anesthesiology
- Patient Recovery Monitoring
- Healthcare Quality Improvement
Background:
- Postanesthesia care unit (PACU) recovery is crucial for pediatric patients.
- Routine assessments prioritize discharge readiness over the child's actual recovery experience.
- Existing measures may not fully capture domains vital to children, families, and clinicians.
Purpose of the Study:
- To review and synthesize measures used in pediatric PACU pathways.
- To assess how these tools evaluate discharge readiness and early recovery quality.
- To understand their coverage of domains important for pediatric recovery.
Main Methods:
- Structured literature review with narrative synthesis.
- Identification and analysis of eight pediatric PACU assessment tools.
- Evaluation of tool coverage across key recovery domains.
Main Results:
- Eight pediatric PACU tools were identified: Steward score, Modified Aldrete Score, physiologic criteria-based score, White and Song fast-track score, Criteria for Fast-Tracking Children, Pediatric Post-Anesthetic Discharge Scoring System, Pediatric Readiness for Discharge Instrument, and Discerning Post Anesthesia Readiness for Transition.
- Tools consistently assessed consciousness, oxygenation, and hemodynamics.
- Assessment of airway, pain, nausea/vomiting, bleeding, and function varied significantly across tools.
Conclusions:
- A gap exists in pediatric-specific, quality-of-recovery measures for the PACU.
- Current tools have limitations in comprehensively assessing pediatric recovery experiences.
- Further research and quality improvement are needed for pediatric PACU recovery assessment.
Abstract:
The postanesthesia care unit is a critical phase of recovery, yet routine assessment often focuses on discharge readiness rather than the child's recovery experience. This study reviewed measures used in pediatric postanesthesia care unit pathways to assess discharge readiness and early recovery quality and synthesized how they capture domains that matter to children, families, and clinicians. This is a structured literature review with narrative synthesis and identified eight tools used in children: Steward score, Modified Aldrete Score, physiologic criteria-based score, White and Song fast-track score, Criteria for Fast-Tracking Children, Pediatric Post-Anesthetic Discharge Scoring System, Pediatric Readiness for Discharge Instrument, and Discerning Post Anesthesia Readiness for Transition. These tools varied by intended phase and destination, with consistent coverage of consciousness, oxygenation, and hemodynamics but variable assessment of the airway, pain, nausea and vomiting, bleeding, and function. A postanesthesia care unit-specific pediatric quality-of-recovery measure remains a key research and quality improvement gap.
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