Extended Post Anaesthetic Care in PACU During COVID-19: Multi-perspective Value-based Analysis

NCT04717089 | Completed

• 1 other identifier: TMH-ExRR-001
• Study Type: observational
• Target: 299
• Locations: 1 country
• Sites: 1

Brief Summary

To evaluate the value-based effectiveness of the implementation of TMH Extended post anaesthetic care in PACU during COVID-19 pandemics by an institutional matched case-control and quantitative survey study Two ordinary recovery beds were converted to an overnight intensive recovery ("Extended post-anesthetic care in PACU") within the operating theatre complex of Tuen Mun Hospital during COVID-19 pandemics, in an attempt to free the ICU bed and resources from postoperative patients. This study was designed to evaluate the efficacy and staff perceptions towards the abrupt implementation of TMH extended post-anesthetic care in PACU by mobilization of the existing OT resources to cope with the COVID-19 emergency situations. The value-based analysis would look into the implementation effectiveness in twofold: 1) the clinical efficacy using a case-control audit on clinical outcomes and 2) the staff acceptance by means of the staff attitudes survey. Hopefully, this would provide a multi-perspective evaluation of the implementation strategies and aid planning of new services in the future.

Conditions

Overnight Intensive Recovery; Postoperative Care

Outcome Measures

Primary Outcomes (1)

• total number of ICU bed days spared

  during study period, up to 1 year

Secondary Outcomes (4)

• amount of healthcare expenditures based on bed occupancy and manpower

  during study period, up to 1 year

• number of unanticipated intensive care unit admission within 48 hours upon discharge to general ward

  48 hour

• rate of elective discharge to the intensive care unit

  After extended post anaesthetic care in PACU service by case. Up to 24 hour

• length of hospital stays

  during admission or patient death, typically up to 1 month

Study Arms (2)

postoperative patients admitted to TMH extended post anaesthetic care in PACU

Exclusion criteria: * Patients awaiting ICU admission in the ordinary recovery room * Patients requiring level 3 intensive care on arrival at the recovery room

Other: overnight intensive recovery / extended post anaesthetic care in PACU

Postoperative patient admitted to ICU with case matched

Inclusion criteria: o Based on case matched with the extended post anaesthetic care in PACU

Interventions

overnight intensive recovery / extended post anaesthetic care in PACU OTHER

From January 2020, during COVID-19 first pandemics in Hong Kong, a bundle of interim measures was implemented with the joint efforts of the Department of Anaesthesia and Operating Theatre Services (A\&OT) and Intensive Care Unit (ICU), and two ordinary recovery beds were converted into extended post anesthetic care in PACU (ExRR), based on the concept of overnight intensive recovery (OIR) to provide level 2 intensive care to patients undergoing major or ultra-major operations or having multiple comorbidities warranted intensive care in the immediately postoperative periods. This was conducted over 3 pandemic waves in Hong Kong.

postoperative patients admitted to TMH extended post anaesthetic care in PACU

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

o The operation periods of TMH Extended post anesthetic care in PACU during COVID-19 and therefore the number of cases included in this study was largely bound by the administrative decision of hospital management based on the ICU bed pressure during COVID-19 situations. All patients being admitted to TMH Extended post anesthetic care in PACU during the three periods of service activation amid COVID-19 pandemics, i.e. from 10 February 2020 to 26 April 2020, from 27 July 2020 to 13 September 2020, from 14 December 2020 to 28 February 2021 were included in this audit. To increase the statistical power above 0.8, a control-to-case ratio of 5 will be adopted for case matching based on the assumption of having the correlation coefficient greater than 0.2 or the prevalence of exposure in the control group less than 0.15.

You may not qualify if:

• Patients awaiting ICU admission in the ordinary recovery room
• Patients requiring level 3 intensive care on arrival at the recovery room

Sponsors & Collaborators

• Tuen Mun Hospital: lead
• Anaesthesia & Operation Theatre Service, Tuen Mun Hospital, Hong Kong: collaborator
• Intensive Care Unit, Tuen Mun Hospital, Hong Kong: collaborator

Study Sites (1)

Tuen Mun Hospital

New Territories, Hong Kong

Location

MeSH Terms

Interventions

Recovery Room

Intervention Hierarchy (Ancestors)

Intensive Care Units; Hospital Units; Health Facilities; Health Care Facilities Workforce and Services

Study Officials

• Carmen Lam

  Tuen Mun Hospital

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical Officer

Study Record Dates

• First Submitted: January 19, 2021
• First Posted: January 20, 2021
• Study Start: February 10, 2020
• Primary Completion: February 28, 2021
• Study Completion: June 30, 2021
• Last Updated: June 28, 2023

Record last verified: 2023-06

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)