Speeds Criteria vs. Modified Aldrete and Fast-Track Criteria for Evaluating Recovery in Outpatients

Brent  Burke; Mark  Kyker

doi:10.4236/ojanes.2013.37068

Brent Burke, Mark Kyker^*

Abstract: Background: The authors have developed criteria utilizing the mnemonic “SPEEDS” (saturation, pain, extremity movement, emesis, dialogue, stable vitals signs) to evaluate and predict which patients would not require phase I nursing intervention and could transition to phase II recovery. Methods: Seventy-three adult surgery patients underwent a standardized general anesthetic. Patients were evaluated with the modified Aldrete, Fast-Track and SPEEDS criteria immediately before leaving the OR and then 5, 10, 15 and 30 minutes after arrival in the recovery area. Results: Significantly more patients met phase I bypass criteria when evaluated with Modified Aldrete (90%) and Fast-Track (94%) as compared to SPEEDS (77%) (p < 0.0429 modified Aldrete vs. SPEEDS, p < 0.0038 Fast-Track vs. SPEEDS). However, SPEEDS was more sensitive having a lower number of patients meeting phase II criteria yet requiring phase I intervention (32%) vs. Fast-track (43%) and Modified Aldrete (44%) (p < 0.001 SPEEDS vs. modified Aldrete and Fast-Track). SPEEDS was more accurate (74%) in predicting which patients should move directly to phase II compared to modified Aldrete (42%) (p < 0.001) and Fast-track (59%) (p = 0.05). Conclusion: SPEEDS criteria are as specific and more sensitive in determining phase I nursing interventions for ambulatory surgery patients when compared to Fast-Track and modified Aldrete criteria.

Keywords: Phase I Bypass; Fast Track; PACU Nursing Interventions

Cite this paper: B. Burke and M. Kyker, "Speeds Criteria vs. Modified Aldrete and Fast-Track Criteria for Evaluating Recovery in Outpatients," Open Journal of Anesthesiology, Vol. 3 No. 7, 2013, pp. 309-314. doi: 10.4236/ojanes.2013.37068.

References

[1] D. A. Lubarsky, “Fast Track in the Post-Anesthesia Care Unit: Unlimited Possibilities?” Journal of Clinical Anesthesia, Vol. 8, No. 3, 1996, pp. 70S-72S. doi:10.1016/S0952-8180(96)90016-1

[2] J. A. Aldrete, “The Post-Anesthesia Score Revisited,” Journal of Clinical Anesthesia, Vol. 7, No. 1, 1995, pp. 89-91. doi:10.1016/0952-8180(94)00001-K

[3] P. F. White, “Criteria for Fast-Tracking Outpatients after Ambulatory Surgery,” Journal of Clinical Anesthesia, Vol. 90, No. 6, 1999, pp. 1178-1190.

[4] T. Greenhalgh, “How to Read a Paper: Papers That Report Diagnostic or Screening Tests,” BMJ, Vol. 315, No. 7107, 1997, pp. 540-543.

[5] E. B. Wilson, “Probable Inference, the Law of Succession, and Statistical Inference,” Journal of the American Statistical Association, Vol. 22, No. 158, 1927, pp. 209-212. doi:10.1080/01621459.1927.10502953

[6] C. J. Clopper and E. S. Pearson, “The Use of Confidence or Fiducial Limits Illustrated in the Case of the Binomial,” Biometrika, Vol. 26, No. 4, 1934, pp. 404-413.

[7] J. L. Fleiss, “Statistical Methods for Rates and Proportions,” 2nd Edition, Wiley, New York, 1981.

[8] D. R. Cox and D. V. Hinkley, “Theoretical Statistics,” Chapman and Hall, London, 1974. doi:10.1007/978-1-4899-2887-0

[9] R. G. Newcombe, “Two-Sided Confidence Intervals for the Single Proportion: Comparison of Seven Methods,” Statistics in Medicine, Vol. 17, No. 8, 1998, pp. 857-872. doi:10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E

[10] J. F. Nelder and R. W. M. Wedderburn, “Generalized Linear Models,” Journal of the Royal Statistical Society A, Vol. 135, No. 3, 1972, pp. 370-384.

[11] A. Macario, T. Vitez, B. A. Dunn and T. McDonald, “Where Are the Costs in Perioperative Care? Analysis of Hospital Costs and Charges for Inpatient Surgical Care,” Anesthesiology, Vol. 83, No. 6, 1995, pp. 1138-1144. doi:10.1097/00000542-199512000-00002

[12] J. L. Apfelbaum, C. A. Walawander and the SAFE Study Team, “Eliminating Intensive Postoperative Care in SameDay Surgery Patients Using Short-Acting Anesthetics,” Anesthesiology, Vol. 97, No. 1, 2002, pp. 66-74. doi:10.1097/00000542-200207000-00010

[13] D. Pavlin, C. Chen and D. Penaloza, “Pain as a Factory Complicating Recovery and Discharge after Ambulatory Surgery,” Anesthesia & Analgesia, Vol. 95, No. 3, 2002, pp. 627-634.

[14] B. A. Williams, M. L. Kentor and J. P. Williams, “PACU Bypass after Outpatient Knee Surgery Is Associated with Fewer Unplanned Hospital Admissions But More Phase 2 Nursing Interventions,” Anesthesiology, Vol. 97, No. 4, 2002, pp. 981-988. doi:10.1097/00000542-200210000-00034