Reliability and validity of a new postoperative track assessment tool (PoTra-tool) as a decision-making aid: A prospective observational study.

Background: Postoperative instruments supporting decision-making for optimal care level are lacking.

Objectives: This study tested the reliability/validity of the postoperative track assessment tool (PoTra-tool) in a postanaesthesia care unit (PACU) and a specialised peri-operative intermediate care unit (IMCU).

Design: A prospective observational study.

Setting: The PoTra-tool consists of two visual analog scales that rate estimated indication (VASi) and benefit (VASb) of care in an IMCU. The tool was tested on day 0 in both units of a Swiss university hospital, and on day 1 in the IMCU.

Participants: Raters were nurses with two levels of competency (noncertified or certified) and physicians with three levels of competency (noncertified, certified, consultant).

Main Outcome Measures: Reliability, between raters and across days, was assessed using intraclass correlation coefficients (ICCs) or weighted kappas. Validity was evaluated with validated scores (severity of illness, nurse workload and predicted mortality). Statistical analysis was carried out using analysis of variance (ANOVA) or Kruskal-Wallis tests.

Results: In total, healthcare professionals performed 4206 ratings for 879 patients with a median [IQR] age of 72 [61 to 81] years) and for American Society of Anesthesiologists physical status scores 4 [4 to 4]. The median [IQR] VASi for PACU patients was 12 [2 to 30] and for IMCU patients, 76 [57 to 89]. Median VASb was 7 [1 to 19] for PACU patients and 66 [43 to 84] for IMCU patients. Internal consistency between VASi and VASb was high (Pearson correlation: 0.90). For each type of rater, reliability of VASi and VASb was acceptable to moderate for inter-rater reliability (weighted kappas: 0.59 to 0.67). The associations tested for construct validity were consistent with expected patterns, although the effect sizes were small.

Conclusion: The PoTra-tool may support the decision-making process in deciding the most appropriate peri-operative level of care for an individual patient: PACU with standard care or IMCU with specialised care.

Trial Registration: ClinicalTrials.gov ID NCT05092867.