Robert Wengritzky

Background To allow better allocation of staff and resources, rapid response teams attending to acutely deteriorating or aggressive patients with suspected or confirmed COVID‐19 infection were pre‐warned with the announcement of 'Code‐95' with calls. Aim To assess healthcare worker (HCW) perspectives on pre‐warning rapid response calls (RRC) with ‘Code‐95’ in announcements when attending to deteriorating or aggressive patients with suspected/confirmed COVID‐19 infection. Methods Design: prospective cross‐sectional single‐centre survey of HCW over a 3‐week period. Setting: tertiary public hospital. Participants: HCW caring for deteriorating or aggressive patients. Main outcome measures: the primary outcome was to assess HCW perspectives in attending Code‐95 calls. Secondary outcomes were to identify any differences related to craft group, age, experience or presence of comorbidities. Results A total of 297 responses was analysed; 86.7% of HCW (n = 257) attending Code‐95 calls reported anxiety. Medical staff reported greater anxiety in comparison to nursing staff (93.8% vs 78.5%; P = 0.002). Efferent team reported higher anxiety in contrast to afferent team (92.6% vs 58.8%; P = 0.021). There was no significant difference in perceived anxiety based on age (≤40 vs >40 years of age), years of experience (≤5 vs >5 years), comorbidities or mental illness; 54% reported concerns about adequacy of infection‐control policies and personal protective equipment; 45% were worried about inadequate training for responding to Code‐95 calls. Conclusions Most surveyed HCW supported Code‐95 announcements pre‐warning them of potential COVID‐19 exposure when attending a RRC. However, the majority of HCW reported anxiety when attending these calls. Medical and efferent team HCW perceived greater anxiety compared to nursing and afferent team HCW. The Code‐95 system to pre‐warn rapid response teams may be a useful addition to protecting HCW from infectious diseases, although broader implementation will require greater resourcing, training and support.

Postoperative nausea and vomiting (PONV) is common but many episodes may be trivial or transient. The aim of the study was to develop a simple-to-use measure of the intensity and clinical impact of PONV. We re-analysed data from a study enrolling 163 patients recovering from surgery and anaesthesia that had experienced or were at increased risk of developing PONV. A range of measures of PONV characteristics and quality of recovery were collected. We devised a simplified nausea–vomiting impact scale based on patients' assessment of the impact of their nausea on their postoperative recovery and the number of times they experienced vomiting. We then undertook further tests of construct and discriminant validity, and reliability and responsiveness, of the impact scale using psychometric methodology. Around one in five patients with PONV had features that could classify them as having clinically important PONV. We found that patients with clinically important PONV had a much poorer quality of recovery (PPP<0.01), when compared with those with lesser degrees of PONV. A change in clinically important PONV status can be reliably detected with the PONV impact scale. We have devised and validated a simplified PONV impact scale that can be used to identify those with clinically important PONV. The avoidance of clinically important PONV could be used as a quality indicator or outcome measure after surgery.

Postoperative nausea and vomiting (PONV) is common and of concern to patients and clinicians. The effect of PONV can range from trivial and transient to major clinical importance, and it is unclear which of its characteristics lead to discomfort and distress. We first enrolled 180 participants (patients, family members, nurses, doctors) to identify the characteristics of clinically important PONV, and from these data developed a measurement scale. We then evaluated the scale in a further 163 patients reporting PONV. Validity, reliability, and responsiveness of the PONV Intensity Scale were tested using psychometric techniques. Most participants agreed that three or more vomits, and greater nausea severity and duration, were key factors in defining clinically important PONV. These data were used to derive a PONV Intensity Scale and a score to define clinically important PONV. The scale identified 29 patients (18%) as having clinically important PONV. Patients with clinically important PONV had a poorer quality of recovery (P<0.0005) and needed twice as much antiemetic treatment (P<0.0005). The scale was strongly associated with PONV consequences and complications, with odds ratios ranging from 6.0 to 31 (all P<0.0005). The scale had excellent reproducibility (intraclass correlation 0.99, P<0.0005). The scale could reliably reflect a clinically important change in health status (effect size 0.82, P<0.0005). The PONV Intensity Scale is a valid, reliable, and responsive measure of clinically important PONV.