Value of phase II pathway in the ambulatory care setting.

Abstract

115 Background: The aim of the project was to decrease PACU (Post Anesthesia Care Unit) time by implementing a Phase II pathway for patients undergoing port-a-cath placement under Monitored Anesthesia Care in the Ambulatory Setting. Methods: The process improvement interventions were centered on eliminating unnecessary patient care processes and increasing patient flow and consisted of: patient and healthcare provider education, phase II unit utilizing existing bed space, revised charting template in the PACU. Queries of our AIMS database for port-a-cath cases performed between January 1, 2012 and February 28, 2013 (pre-intervention) and then between May 1, 2013 and May31, 2014 (post-intervention) were obtained. March 1, 2013 to May 1, 2013 was a transition period used to implement the process. Only cases performed under monitored anesthesia care were included. Cases with a PACU length of stay greater than 200 minutes were excluded from the study as these patients were no longer fast track. Descriptive statistics were used to summarize PACU length of stay pre/post-intervention. Scatter plots were used to show the variability in PACU length of stay and to illustrate the average trajectory of PACU length of stay over each time frame. A t-test was used to compare the average length of stay in the PACU, pre/post-intervention. Results: There were 917 pre-intervention cases and 362 post intervention cases. Trend of minutes spent in the PACU over time is illustrated (Figure 1). The average number of minutes in the PACU during the pre-intervention was 86.8. During the post-intervention, it was 67 minutes (Difference = 19.6 minutes; p-value < 0.001). Conclusions: As a result of implementing a phase II pathway for patients undergoing port-a-cath placement, there was a significant decrease in average time spent in the PACU. In addition, there was a decrease in the variation associated with PACU length of stay. The phase II pathway allowed a significant subgroup of this patient population to be less sedated after surgery and proceed directly to chemotherapy or their next scheduled appointment in the institution. Time and cost savings to the patient and the institution were additional benefits.