Effect of an anaesthesia department led critical care outreach and acute pain service on postoperative serious adverse events

• Published in: Anaesthesia Vol. 61; no. 1; pp. 24 - 28
• Main Authors: Story, D. A., Shelton, A. C., Poustie, S. J., Colin‐Thome, N. J., McIntyre, R. E., McNicol, P. L.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.01.2006; Blackwell; Blackwell Publishing Ltd
• Subjects: Aged; Anesthesia; Anesthesia Department, Hospital - organization & administration; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical care; Critical Care - organization & administration; Female; Health Services Research - methods; Humans; Male; Medical sciences; Middle Aged; Pain Clinics - organization & administration; Pain management; Pain, Postoperative - prevention & control; Patient Care Team - organization & administration; Postoperative Care - methods; Postoperative Complications - prevention & control; Prospective Studies; Surgery; Victoria; Victoria; Australia; Postoperative; Anesthesia; Complication; Pain
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.2005.04435.x

Summary We examined whether a combined critical care outreach and acute pain service comprising both medical and nursing staff from the Department of Anaesthesia would decrease the incidence of postoperative serious adverse events in a hospital with an established Medical Emergency Team. We called this combined service IMPACT: Inpatient Management of acute Pain and Advice on Clinical Treatment. We conducted a prospective, before‐and‐after trial with a baseline phase (319 patients) of standard acute pain management followed by the IMPACT phase (271 patients), during which the IMPACT team systematically reviewed high‐risk postoperative patients for the first three days after their return to the general wards. The incidence of serious adverse events decreased from 23 events per 100 patients to 16 events per 100 patients. The 30‐day mortality decreased from 9% to 3%, p = 0.004. An acute pain service providing critical care outreach may improve postoperative outcome but the workload is considerable.