Scoring systems are being used increasingly to help identify patients at risk of physiological deterioration, thus prompting timely intervention. Studies suggest that the indiscriminate use of these scoring systems may not always be beneficial as they may lack specificity [Cuthbertson and Smith, Reference Cuthbertson and Smith2007]. This article aims to describe a scoring system developed by the author for a unique purpose.

The Post-anaesthetic Scoring System (PASS), a weighted aggregate assessment tool, was developed exclusively for use in the post-operative recovery area to aid assessment of adult patients emerging from balanced anaesthesia, and recovery from regional anaesthesia or sedation. Its basis lies upon recommendations from governmental departments [National Institute of Clinical Excellence [NICE, 2007, 2008]], professional bodies like the Royal College of Anaesthetists [RCA, 2006] and the Association of Anaesthetists of Great Britain and Ireland [AAGBI, 2002], supportive studies Cuthbertson et al [Reference Cuthbertson, Boroujerdi, McKie, Aucott and Prescott2007], Duckitt et al [Reference Duckitt, Buxton-Thomas, Walker, Cheek, Berwick, Venn and Forni2007] and input from medical professionals. It aims to provide a comprehensive tool fit for the purpose. The following text describes its layout and use.

The PASS document consists of a four-page booklet. The front cover, page one, incorporates the title, text regarding patient safety, space for patient information and identification of the anaesthesia used. Placed in the centre are two interlocking triangles symbolising the interaction of the triad of anaesthesia with the cardiovascular, respiratory and central nervous systems. Its purpose is as an aide-memoire for practitioners with each of the six points alluding to factors, or assessment scales (ex) adapted from Morgan et al [Reference Morgan, Williams and Wright1997] to be considered during patient management.

Page two containing the PASS uses a familiar logical A (airway), B (breathing), C (circulation) sequence as an established format for assessment of crucial physiological parameters regarded as fundamental in the delivery of critical care [Resuscitation Council UK, 2006]. Each parameter offers two or three weighted options reflecting the patient's current status. Page three is the physiological measurement recording chart, and it also shows the key to the symbols used in the document. Page four allows written evaluation and discharge criteria verification.

Use of the tool begins immediately upon admittance to the recovery area.

Assessment is initially in two parts during which parameters A, B, C, C (consciousness) are assessed and scored. Once the patient is conscious and verbally able to express their needs parameters in D (discomfort), undergo the same process. An aggregate combined score of all parameters, equal to or greater than ten, must be obtained on two consecutive occasions before discharge can be considered. An increasing score indicates improvement. Any score less than ten requires constant reassessment with appropriate intervention. An optimum score of twelve is achievable and preferable, or thirteen if urinary output measurement is requested or accurately measurable. Conscious patients undergoing regional anaesthesia only can be assessed using all parameters initially. Temperature measurement is obtained only once if acceptable, and this initial score is carried throughout the recovery phase. Any additional information regarding care the patient has or is to receive may be recorded in E(evaluation) and the discharge protocol verified.

A small comparative pilot study using PASS and an assessment tool currently in use was undertaken locally to establish the capacity of PASS to provide documentation reflective of the unique physiological process involved during emergence from chemically induced states. Respondents were asked to rate layout, suitability of parameters and clarity of documentation.