The development of a Nursing Acuity Score for the care of postoperative patients undergoing elective colorectal resection

1.1 Background: With the increasing number of laparoscopic colorectal resections performed worldwide there is a need to examine changes in the nursing care being delivered postoperatively. There have been no studies to date conducted to measure the difference in nursing hours and effort required to care for patients who have had laparoscopic colorectal resections when compared with open colorectal resections in the acute post operative period. 1.2 Aim: To develop a tool to measure and define nursing effort in the postoperative care of patients undergoing colorectal resection. This would assist with decision making around staff resourcing and skill mix that could benefit perceived nursing workload and the quality of patient care. 1.3 Objectives: - To examine nursing views about differences in postoperative workload between invasive and minimally invasive colorectal procedures through the development of a survey of specialised colorectal nurses (n=19). A 7 point visual analogue Likert Scale was used to rate their responses. - To develop and pilot a tool, The Concord Nursing Acuity Score, to a small sample of colorectal surgical patients (n=15) - To apply the Concord Nursing Acuity Score to two larger cohorts of Laparoscopic patients (n=46) and Open patients (n=42). - To determine through statistical analysis whether the tool was useful in detecting a statistically significant difference in Nursing Acuity Scores between the invasive and minimally invasive cohorts. 1.4 Methods: Nursing perceptions were assessed by a questionnaire. The questionnaire was developed by the author in collaboration with senior nursing and medical colleagues of the colorectal department. Following completion of the nursing perception assessment, an acuity tool was developed. Six nursing activities were chosen for inclusion. These were diet/feeding, drains and catheters, wound management, vital observations, intravenous and parenteral infusions/medications, mobility and assistance with Activities of Daily Living (ADL’s). Data was also collected on age, sex, Body Mass Index (BMI) and an American Society of Anaethesiology (ASA) score. Each nursing activity was assigned a score and a time. A pilot study of 15 patients was first conducted to assess the tool. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS). 1.5 Results: Nineteen of 23 nurses returned a completed survey. The results from the perception study found that nurses perceived the post operative care for patients undergoing laparoscopic surgery required less time and effort. Eighty eight patients were included in the full population study. Forty one patients underwent open colorectal resection and 42 patients underwent laparoscopic colorectal resection. Five patients were converted from laparoscopic to open but were included in the laparoscopic group. In all measured nursing activities there was a statistically significant lower score and time in the laparoscopic group compared with the open group. There was also a strong statistically significant correlation between nursing time and the acuity score. 1.6 Conclusion: This study has developed a tool which has demonstrated there is a measureable difference in the nursing time and effort required to care for patients who have had elective laparoscopic colorectal resections when compared with patients who have had elective open colorectal resections in the acute post operative period. This study will allow managers to appreciate how demanding the workload is for nursing staff on colorectal surgical wards and the importance of staffing a mix of adequate specialised nurses and allied health staff to ensure optimal patient care. Further research could determine the “generalisablity” of the Concord Nursing Acuity Score to other clinical populations.