Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewThe future of recovery - Integrated, digitalised and in real time.
Traditional perioperative risk prediction recovery identifies patient populations at risk of suboptimal recovery but not individual patients in whom this actually occurs and in whom timely intervention is beneficial. Patient-focused recovery emphasises a return to a semblance of normality and an ability to perform activities previously undertaken. ⋯ Real-time recovery (RTR) assessment is the contemporaneous collection, analysis and reporting of data that enable the identification of suboptimal recovery in individual patients in a timeframe that minimises the delay in the implementation of the targeted treatment. There is a need to validate the clinical utility of existing biometric technology, wireless hybrid devices and digitalised platforms in providing both clinician and patient with RTR data and to determine the effect, if any, that RTR has on patient engagement and outcome.
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewApproaches to the measurement of post-operative recovery.
Modern recovery assessment has progressed from that which addressed purely physiological restitution in the immediate post-operative period to that which is a multi-dimensional construct existing as a continuum and which follows a predictable trajectory. Recovery tools differ in their derivation, validation and scope of assessment. ⋯ Dichotomisation of recovery assessment mandates that a threshold be determined, above which recovery is deemed to have occurred. Ideally, recovery is assessed as a dichotomous outcome using the patient as their own pre-operative comparator, thus allowing recovery assessment at an individual patient, as well as group, level and overall as well as within each recovery domain.
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewThe patient's surgical journey and consequences of poor recovery.
Quality of recovery is a multidimensional construct that affects individual patients in different ways and during different time periods. The evaluation of quality of recovery requires patient-reported outcome measurement tools that are sensitive in detecting change with time and are preferably objective rather than subjective by nature. Current surgical outcomes are still predominantly focused on the avoidance of complications and reduced cost. ⋯ However, it is critical to maintain the high standards of surgical safety and cost containment as we move forward to address value-based care. An apparently successful surgery can result in poor recovery outcomes such as cognitive decline, persistent pain, reduced functional ability, loss of independence or inability to return to work. The special edition of Best Practice will focus on the multidimensional construct of quality of recovery, how to measure it and how it may apply in different populations.
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewIntegration of satisfaction and quality of recovery.
Among patient-reported outcomes, patient satisfaction and quality of recovery are key measures of patient-centred care. The measurement of patient satisfaction should use validated, multidimensional scales. There are general scales that aim to evaluate the entire perioperative period and scales focused on specific periods (post-operative) or techniques (loco-regional anaesthesia). ⋯ Improving patient satisfaction goes beyond quality improvement. In a large database, the highest satisfaction was associated with the lowest morbidity and mortality. Thus, it is likely that the process of improving quality changes multiple components of medical management, hence improving several patient outcomes.
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewA matter of perspective - Objective versus subjective outcomes in the assessment of quality of recovery.
Current post-operative recovery assessment exists as a dichotomy, maintaining objectivity whilst providing relevance to patient-centred care. Both objective and subjective measures are utilised in modern recovery assessment and are best viewed as complimentary. ⋯ Patient-reported outcomes prioritise the patient's perspective of symptoms and care, which are the most important aspects at the time of assessment but are limited by their susceptibility to response shift and recall bias. Ideally, quality of recovery is assessed using objective measures in concert with measures of clinical complexity and in parallel with patient-reported outcomes.