Authors (including presenting author) :
HUI KY(1), HUI LK(1), CHU WL(1), LAW NW(1), MOK YT(1)
Affiliation :
(1)OPERATING THEATRE, HONG KONG CHILDREN’S HOSPITAL
Introduction :
Post anaesthesia care is essential care provided for postoperative patients. In 2024, a monthly average of 247 paediatric patients received postoperative care in the Post-Anaesthesia Care Unit (PACU), of which approximately 34% were planned for day discharge. To improve the quality and efficiency of care, a nurse-led discharge (NLD) programme was implemented in March 2024, in which discharge from anaesthetists is no longer compulsory for those eligible cases. The NLD of adult patients was a widely accepted practice in Hong Kong, only one local hospital included patients older than 10 years old, still no younger than 10 years old, as the complexity of paediatric care, variable in paediatric ages and conditions.
Objectives :
(1)To reduce the need for anaesthetist discharge; (2)to improve discharge efficiency; and (3)to enhance nurse competency
Methodology :
A standardized protocol, including specific discharge criteria, is developed. Nurses who have completed the PRCC in either Anaesthetic and Recovery Nursing or Perioperative Nursing, and completed the paediatric sedation course, also have at least 6-months experience in operating theatres and PACU of HKCH, will receive comprehensive training. The NLD training includes postoperative monitoring, patient assessment and discharge criteria. Nurses are assessed for competency in applying these protocols as well as managing patient concerns. After 9 cases under supervision of a nurse trainer and 1 case assessed by anaesthesia fellow, they will be qualified to discharge patients independently.
Result & Outcome :
Although small sample size due to the short implementation period and lack of qualified nurses, the result was encouraging. From March to December 2024, a total of 6 nurses were qualified, while 3 are currently undergoing the training. In total 97 patients of day discharge cases were referred to NLD, of which nurses successfully assessed 11% of them required anaesthetists for reassessment and discharge due to surgical wound pain, prolonged sedation, agitation and respiratory problems.
Around 82% of NLD patients were below the age of 10 and the rest of them range from 10 years to 17 years old. Those cases include 3 different surgery magnitudes, 28% of major cases, 25% intermediate and 47% of minor cases.
The discharge time decreased 12.5% compared to anaesthetist discharge cases. No reported incident or complication. Hence, this could enhance early patient discharge to home. The longer implementation time and more qualified nurses will lead to greater success.
