# Effectiveness of the Semi‐Automated Post‐ANaesthesia Discharge Assessment Tool: A Pre‐Post Study Using Propensity Score Matching

## TL;DR

A semi-automated tool called PANDA reduced the time patients spend in the post-anesthesia care unit and was well accepted by nurses.

## Contribution

The study demonstrates that a semi-automated discharge assessment tool significantly reduces PACU length of stay using electronic patient data and propensity score matching.

## Key findings

- The PANDA tool reduced median PACU length of stay by 16 minutes after implementation.
- PACU nurses reported high acceptance and feasibility of the PANDA tool.
- The tool improved standardization and decision-making in PACU workflows.

## Abstract

Discharge management and workflow efficiency in a postanaesthesia care unit (PACU) can be improved with specific tools assessing discharge readiness. Several authors have found tools to reduce the PACU length of stay (PACU LOS), but results have remained inconsistent.

We analysed the effects of the Post‐ANaesthesia Discharge Assessment tool (PANDA) on PACU LOS, operating room (OR) holds, PACU nurses' confidence with the discharge decision and their perception of the tools' implementation.

This pre–post study with a propensity‐matched historical control group evaluated the impact of the semi‐automatic PANDA tool in a single primary‐level hospital. The tool supports discharge decisions in the PACU. Median PACU LOS pre‐ and post‐implementation was compared using nearest‐neighbour propensity score matching and weighted linear regression. OR holds were analysed over 20 consecutive days. A structured nurse survey assessed confidence in discharge decisions and perceptions of the tool's implementation.

The study included 8475 patients (pre n = 4509; post n = 3966) and 19 nurses. Median PACU LOS before implementing the PANDA tool was 114 min (IQR 89–144) compared to 103 min (IQR 79–136) after the implementation. The weighted linear model showed an estimated difference in PACU LOS of −16 min (95% CI from −20 to −12 min, p < 0.001). There were too few OR holds for comparison. PACU nurses' confidence in their discharge decision remained unchanged before and after implementation. The PANDA tool received high ratings for acceptability, appropriateness, compatibility and feasibility.

Implementing the semi‐automated PANDA discharge tool significantly decreased PACU LOS. In addition, PACU nurses reported high acceptance, usefulness and feasibility of the tool. The PANDA discharge tool may optimise routine clinical practice to streamline PACU workflows, support resource allocation and decision‐making and promote standardisation. Reducing PACU LOS may also improve patient flow and capacity planning in high‐volume settings.

The semi‐automated PANDA tool was well received by nurses who perceived it as useful and feasible. Given the significant reduction in PACU length of stay, integrating PANDA into clinical practice may enhance post‐surgical patient flow and resource allocation, while its main added value lies in improving standardisation, supporting decision‐making and PACU workflow.

What is known about this topic?
○Timely discharge from the postanaesthesia care unit (PACU) is essential for optimising patient flow and efficient use of resources.○Structured discharge tools have shown potential to reduce PACU length of stay (LOS), though previous studies were often limited by small samples, inadequate controls or methodological bias.○Additional documentation burdens may hinder tool adherence by nurses, highlighting the need for systems that integrate into existing clinical workflows.
What this paper adds?
○This study showed that a semi‐automated discharge tool (PANDA), which draws on routinely documented electronic patient data, significantly reduced PACU LOS in a large pre–post analysis using propensity score matching.○PACU nurses reported high levels of acceptance, usefulness and feasibility, indicating strong potential for sustainable implementation.○PANDA's main added value lies in improving standardisation, supporting decision‐making, and PACU workflow.

What is known about this topic?
○Timely discharge from the postanaesthesia care unit (PACU) is essential for optimising patient flow and efficient use of resources.○Structured discharge tools have shown potential to reduce PACU length of stay (LOS), though previous studies were often limited by small samples, inadequate controls or methodological bias.○Additional documentation burdens may hinder tool adherence by nurses, highlighting the need for systems that integrate into existing clinical workflows.

Timely discharge from the postanaesthesia care unit (PACU) is essential for optimising patient flow and efficient use of resources.

Structured discharge tools have shown potential to reduce PACU length of stay (LOS), though previous studies were often limited by small samples, inadequate controls or methodological bias.

Additional documentation burdens may hinder tool adherence by nurses, highlighting the need for systems that integrate into existing clinical workflows.

What this paper adds?
○This study showed that a semi‐automated discharge tool (PANDA), which draws on routinely documented electronic patient data, significantly reduced PACU LOS in a large pre–post analysis using propensity score matching.○PACU nurses reported high levels of acceptance, usefulness and feasibility, indicating strong potential for sustainable implementation.○PANDA's main added value lies in improving standardisation, supporting decision‐making, and PACU workflow.

This study showed that a semi‐automated discharge tool (PANDA), which draws on routinely documented electronic patient data, significantly reduced PACU LOS in a large pre–post analysis using propensity score matching.

PACU nurses reported high levels of acceptance, usefulness and feasibility, indicating strong potential for sustainable implementation.

PANDA's main added value lies in improving standardisation, supporting decision‐making, and PACU workflow.