TY - JOUR
T1 - The Role of Feedback Training on Early Postoperative Recovery and Anxiety Scores in an Ambulatory Surgical Unit
T2 - A Secular Trend Study
AU - Dukhan, Alexander
AU - Yusupov, Teymur
AU - Kabra, Naama
AU - Ezri, Tiberiu
AU - Boaz, Mona
N1 - Publisher Copyright:
© 2024 University of Medicine and Pharmacy Targu Mures. All rights reserved.
PY - 2024/10/1
Y1 - 2024/10/1
N2 - Background: We used a ten-item postoperative quality of recovery score (QoR-10) to assess the perioperative quality of care in an in-hospital ambulatory surgical unit. Methods: In Phase 1 of this secular trend study (n=300 patients, 3-months duration), we collected QoR-10 scores and potential confounders, including type of anesthesia and surgery; co-morbidities; and anesthesia components of the Amsterdam scale-measured anxiety scores. Phase 2 was the one-month performance feedback learning phase in which modifiable variables identified in Phase 1 were translated to actionable steps, reinforcing the already existing routine of our department’s clinical practices, including pain, shivering and anxiety. The anesthesiology team was instructed and reminded of these steps using performance feedback methods. In Phase 3 (n=300 patients, 3-month duration) we evaluated the efficacy of this performance feedback instruction. QoR-10 scores were compared between Phase 1 and Phase 3. Results: Phase 1 identified three modifiable variables as targets for improvement: postoperative shivering; percentage of patients with numerical rating pain scale (NRS)<4; and preoperative anxiety from anesthesia scores. Compared to Phase 1, significantly fewer Phase 3 patients had severe shivering (2.3% vs. 7.3%, p = 0.023), and a greater percentage had NRS < 4 points (79% vs. 49.7%, p <0.001). The percentage of patients with a high anxiety score did not differ between phases. A direct association between anxiety score and QoR-10 score was not detected. The QoR-10 score (median (IQR)) was significantly higher in Phase 3 than Phase 1: 50 (49-50) vs. 49(49-50), p<0.001. In a multivariable logistic regression analysis, odds for a QoR-10 score of 49-50 were 1.92 higher in Phase 3 than Phase 1. Conclusion: Considering the study limitations, team feedback education contributed to improvement of the QoR-10 score, reduced the proportion of patients with severe shivering and increased the percentage of patients with low pain scores.
AB - Background: We used a ten-item postoperative quality of recovery score (QoR-10) to assess the perioperative quality of care in an in-hospital ambulatory surgical unit. Methods: In Phase 1 of this secular trend study (n=300 patients, 3-months duration), we collected QoR-10 scores and potential confounders, including type of anesthesia and surgery; co-morbidities; and anesthesia components of the Amsterdam scale-measured anxiety scores. Phase 2 was the one-month performance feedback learning phase in which modifiable variables identified in Phase 1 were translated to actionable steps, reinforcing the already existing routine of our department’s clinical practices, including pain, shivering and anxiety. The anesthesiology team was instructed and reminded of these steps using performance feedback methods. In Phase 3 (n=300 patients, 3-month duration) we evaluated the efficacy of this performance feedback instruction. QoR-10 scores were compared between Phase 1 and Phase 3. Results: Phase 1 identified three modifiable variables as targets for improvement: postoperative shivering; percentage of patients with numerical rating pain scale (NRS)<4; and preoperative anxiety from anesthesia scores. Compared to Phase 1, significantly fewer Phase 3 patients had severe shivering (2.3% vs. 7.3%, p = 0.023), and a greater percentage had NRS < 4 points (79% vs. 49.7%, p <0.001). The percentage of patients with a high anxiety score did not differ between phases. A direct association between anxiety score and QoR-10 score was not detected. The QoR-10 score (median (IQR)) was significantly higher in Phase 3 than Phase 1: 50 (49-50) vs. 49(49-50), p<0.001. In a multivariable logistic regression analysis, odds for a QoR-10 score of 49-50 were 1.92 higher in Phase 3 than Phase 1. Conclusion: Considering the study limitations, team feedback education contributed to improvement of the QoR-10 score, reduced the proportion of patients with severe shivering and increased the percentage of patients with low pain scores.
KW - anesthesia
KW - feedback training
KW - PACU
KW - performance assessment
KW - recovery score
KW - secular trend
UR - http://www.scopus.com/inward/record.url?scp=85215555542&partnerID=8YFLogxK
U2 - 10.2478/jccm-2024-0036
DO - 10.2478/jccm-2024-0036
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AN - SCOPUS:85215555542
SN - 2393-1817
VL - 10
SP - 353
EP - 360
JO - Journal of Critical Care Medicine
JF - Journal of Critical Care Medicine
IS - 4
ER -