Perioperative Medical Emergencies in a 23-Hour Surgical Procedure Unit

Abstract

Purpose

Our 174-bed hospital operates a 23-hour/day procedure unit without a dedicated on-site high dependency unit or intensive care unit. The purpose of this investigation is to assess the incidence of medical emergency response (MER) and Code Blue (CB) events over 12 months.

Patients and Methods

A retrospective analysis of hospital records was conducted. Patients were identified using the medical emergency team (MET) database. Information pertaining to whether the patient was pre-operative, post-operative (including time and characteristics of the operation), or medical short stay overflow was obtained, in addition to the reason for the MER/CB event and outcome of the event.

Results

Of all hospital events, 8.45% (47 of 550) occurred in the perioperative ward. The incidence rate of events was 0.76% (95% CI: 0.53% to 0.99%) of all scheduled operations. The surgical procedure cancellation rate due to pre-operative MER/CB events was 0.11% (95% CI: 0.02% to 0.20%). Orthopedic surgery and ENT surgery were associated with the highest incidence of MER/CB events. Post-operative hypotension and reduced consciousness associated with vasovagal episodes were the most common clusters. The mean time after the operation for events to occur was 5.21 hours. 25.5% of events occurred outside of standard day surgery operating hours when there was limited access to onsite consultant anaesthetic or surgical staff (17:00 to 08:00).

Conclusion

This study highlights the anticipated medical emergencies for a 23-hour procedural unit and is of particular interest for evaluation by other short stay surgical, outpatient procedural, or rural hospital surgical units with limited after hours on-site critical care support.

Keywords:

• medical emergency response
• critical care
• perioperative
• 23-hour surgical

Acknowledgments

We would like to acknowledge Ms Victoria Eaton, Nurse Consultant in Critical Care for maintaining the MET database. We would also like to acknowledge Dr James Chua, Chair of Modbury Hospital MET subcommittee.

Abbreviations

MER, medical emergency response; CB, Code Blue; MET, medical emergency team; ICU, intensive care unit; HDU, high dependency unit.

Ethics

Ethics approval was sought and granted by Central Adelaide Hospital Local Network Human Research and Ethics Committee (reference number 13,358).

Disclosure

The authors report no conflicts of interest in this work.