Abstract
BackgroundIn the post-anesthesia care unit in our hospital, selected postoperative patients receive care from anesthesiologists and nursing staff if these patients require intensive hemodynamic monitoring or treatment to stabilize vital functions (e.g., vasopressor use and mechanical ventilation support) during a one-night admission. We investigated the agreement between elective preoperative planning for post-anesthesia care unit admission and the postoperative reality, along with the consequences of planning failures.MethodsData from records for 479 consecutive patients from June 1 to November 30, 2014, in a tertiary referral hospital were reviewed and analyzed. All patients admitted to PACU were included, along with patients scheduled to be referred to PACU but ultimately transferred to another ward. The primary outcome was the efficiency of planning PACU admission for elective patients. Secondary outcomes included secondary admissions to PACU or the intensive care unit (ICU) and 30-day morbidity and mortality.ResultsOf the 479 included patients, 342 (71%) were admitted per preoperative planning. Five patients (1%) needed cardiopulmonary resuscitation, and six (1%) did not survive the follow-up period. Patients admitted to PACU because of a shortage of beds in the ICU had the highest readmission (20%) and mortality rates (20%) (P = 0.01).ConclusionsPreoperative planning for PACU admission was off-target for 29%. However, efficient care always takes precedence over efficient planning. In particular, downgrading patients to PACU because of a shortage of beds in the ICU was associated with a mortality increase.
Highlights
In the post-anesthesia care unit in our hospital, selected postoperative patients receive care from anesthesiologists and nursing staff if these patients require intensive hemodynamic monitoring or treatment to stabilize vital functions during a one-night admission
We hypothesized that preoperative planning of elective surgery according to our inclusion and exclusion criteria (Appendices 1a and 1b) would result in an optimal occupation of about 85% of our post-anesthesia care unit (PACU) beds, which is based on internal business plans and estimations according to the Queuing theory [4,5,6]
Because of cancellation or delay of their procedure, 19 patients were included more than once in the database because they had more than one PACU indication
Summary
In the post-anesthesia care unit in our hospital, selected postoperative patients receive care from anesthesiologists and nursing staff if these patients require intensive hemodynamic monitoring or treatment to stabilize vital functions (e.g., vasopressor use and mechanical ventilation support) during a one-night admission. We investigated the agreement between elective preoperative planning for post-anesthesia care unit admission and the postoperative reality, along with the consequences of planning failures. In the post-anesthesia care unit (PACU) in our hospital, selected postoperative patients receive care from anesthesiologists and nursing staff if these patients require intensive hemodynamic monitoring or treatment to stabilize vital functions (e.g., vasopressor use and mechanical ventilation support) during a one-night admission [1]. Our goal was to facilitate the maximum number of elective procedures while minimizing the cost of empty beds without risking a backlog of other elective surgeries
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