Speeds Criteria vs. Modified Aldrete and Fast-Track Criteria for Evaluating Recovery in Outpatients 313
some as well as lenient. For example, currently accepted
criteria require calculating deviations from preoperative
hemodynamic parameters as well as allow a patient to
experience transient emesis and pain requiring intrave-
nous analgesia yet still meeting fast track criteria. It
should be noted the authors of Fast-Track criteria did
suggest further validation [3]. The current study was our
initial attempt to see if SPEEDS could predict which pa-
tients would not require phase I nursing treatment and
could proceed to phase II with confidence, thereby fa-
cilitating our fast track program.
In analyzing our data, we defined a po sitive test as be-
ing able to determine those patients who required phase I
nursing interventions. A very sensitiv e test would have a
low “false negative” rate or in this case, a low rate of
bypass for those who subsequently required phase I
nursing interventions. A very specific test would have a
low “false positive” rate or in this case, a low number of
patients who did not meet bypass criteria but did not re-
quire phase I nursing intervention post-op. All three tests
were specific in identifying patients that required phase I
nursing interventions post-operative. With SPEEDS cri-
teria, significantly more patients were co rrectly identified
as eligible for bypass. Only 32% of SPEEDS eligible
patients needed a phase I intervention compared to 44%
with Fast-Track criteria and 43% with modified Aldrete
(p < 0.001 vs. both Fast-Track and modified Aldrete). In
other words, when SPEEDS determined a patient could
move to phase II, the clinician is more assured that the
patient will not require phase I intervention. Also the
accuracy of SPEEDS was significantly greater than either
Fast-Track (74.0% vs. 58.9%; p = 00.005 or modified
Aldrete (74.0% vs. 42.5%; p < 0.0001). Th is may help an
institution in determining nurse to patient ratios.
Longitudinal analysis revealed statistically significant
differences in bypass rates at all times studied. SPEEDS
ineligible patients continued to not meet requirements
because of the need for phase I interventions; whereas,
the majority of these patients met criteria via the other
two methods over the first 30 minutes of recovery.
SPEEDS continued to be more sensitive and could be
used as criteria in the PACU for transition from phase I
to phase II.
The majority of phase I interventions in bypass eligi-
ble patients were for IV analgesia with all 3 criteria. This
data support Pavlin’s [13] findings that improvements in
pain therapy are needed to expedite recovery. Although
not specifically addressed in this study, surgical inva-
siveness seemed to correlate with suitability for bypass.
More invasive and hence painful procedures tended to
require more nursing intervention for post-operative an-
algesia and this need should be anticipated when imple-
menting bypass strategies [14]. The second most com-
mon intervention in bypassed patients was for IV anti-
emetic therapy. Similarly, anti-emetic prophylaxis for
patients at risk is a logical part of bypass strategies [14].
Opportunities exist for further study into the impact of
various pain management and anti-emetic modalities on
successful phase I bypa ss.
Readers may question whether our technique is to just
wait until the patient is ready for phase II, however; this
was not the case as our average time from discontinuing
the agent until arriving in the PACU was 6.6 minutes.
Some may question the value of utilizing bypass criteria
in a facility without a traditional recovery area. We have
found that SPEEDS criteria give a better idea as to which
patients are more likely to need phase I intervention and
thus require higher nursing acuity and feel this could be
used quite effectively in a traditional set up as well.
Although the accuracy of SPEEDS is significantly
better than the other criteria, a fairly large percent of pa-
tients are bypassed and eventually need Phase I interven-
tion. In part, this finding is a reflection of the dynamic,
changing nature of post-operative recovery. What seems
to be an adequate recovery can quickly change because
of motion-induced nausea and vomiting or the unmask-
ing of pain following the elimination of residual anesth e-
sia. Due to the interpatient variability in analgesic re-
quirements, it is difficult to predict which bypassed pa-
tients will require phase I nursing intervention and sub-
sequently relapse. Further efforts to control and eliminate
these issues are warranted.
In developing the SPEEDS criteria, one goal was a
user-friendly mnemonic. We felt that using extremity
movement to command would be an adequate substitute
for the standard 5 second head lift. Our goal is to have
the patient move to the gurney without assistance upon
completion of the surgery. Although the range of vital
signs may seem arbitrary, their utilization did not affect
patient outcomes. Perhaps, if a clinician is un comfortable
with these values, then they could substitute their own
values accordingly.
This study could be criticized for the relatively small
number of patients, although statistically viable. Also,
our surgery center is atypical in its layout, although we
feel it is an advantage in our practice. Lastly, we only
carried out the evaluation for 30 minutes which often is
not enough time to adequately control pain or nausea in
certain cases (e.g., laparoscopic cholecystectomy).
In summary, the authors examined the use of an easily
applied mnemonic for evaluating fast track recovery in
outpatients following general anesthesia. The SPEEDS
criteria are self-explanatory and require a yes/no re-
sponse without calculations for deviations from pre-ope-
rative blood pressure. SPEEDS criteria are significantly
more sensitive and accurate in identifying patients who
will require phase I nursing interventions. Therefore, it
appears SPEEDS has advantages over Fast-Track Scor-
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