Original contributionUse of postanesthesia discharge criteria to reduce discharge delays for inpatients in the postanesthesia care unit
Introduction
Numerous studies have analyzed postanesthesia care unit (PACU) discharge procedures, focusing on factors that might or might not decrease PACU time [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Some of this work evaluated how the choice of anesthetic management could influence PACU time. Several studies showed that the use of insoluble anesthetic agents and/or rapidly acting intravenous drugs such as propofol or remifentanil could significantly reduce PACU length of stay [1], [2], [3], [4].
We believe that patient stays in PACU are often unnecessarily prolonged because of delays in receiving discharge orders. These discharge delays may reduce PACU resources and may create an operating room backlog. We speculate that using predetermined, criteria-based discharge as opposed to traditional discharge after contemporaneous physician evaluation may decrease PACU length of stay.
Currently, there are practice standards available permitting the autonomy of nurses to discharge inpatients without a physician at the bedside [6]. However, only a few studies that compared physician discharge with nurse discharge using predetermined criteria have also evaluated differences in discharge times and complications. The primary aim of this study was to determine if inpatients discharged by a nurse following predetermined discharge criteria reduces PACU length-of-stay and increases efficiency compared with the standard anesthesia practice of contemporaneous physician discharge. A secondary aim of the study was to compare the condition of inpatients, discharged via criteria versus the traditional physician discharge evaluation, on arrival to the floor.
Section snippets
Materials and methods
After obtaining permission from the Loyola University Medical Center Institutional Review Board to conduct this study, we then followed two groups of patients. Group 1 consisted of patients who were discharged from the PACU by the anesthesiologist after PACU nurse notification and physician evaluation of discharge readiness (traditional discharge group [TDG]). Each physician used individual evaluation criteria and judgment for patient discharge from PACU. Group 2 individuals were discharged
Results
The demographic data of both groups were comparable (Table 2). Discharge times were shorter in the DCG group when compared with those from the TDG group (Table 3). The difference in time that discharge criteria were met to actual time leaving the PACU was also shorter in the DCG group (Table 3). The number of patients whose PACU stay exceeded 60 and 75 minutes was higher in the TDG than in the DCG. The PACU discharge delays for the TDG group were more than double that of the DCG group (Table 3
Discussion
We have shown that implementing a set of predetermined discharge criteria reduces PACU length of stay by 24% when compared with traditional physician discharge. This difference occurred primarily because of the extra time that it takes to obtain a physician's order. (Discharge delay was defined as an excess of 15 minutes after the PACU nurse believed the patient was ready for discharge.) One fifth of the overall rate for PACU discharge delay was due to inability to obtain a physician's order in
Conclusion
Our study shows that predetermined discharge criteria resulted in a 24% decrease in PACU time when compared with patients discharged by physician evaluation. The use of predetermined discharge criteria resulted in no apparent increase of adverse events. Patients were stable, and nurse-evaluated discharge resulted in improved discharge times without apparent compromise of patient status.
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2021, Journal of Perianesthesia NursingCitation Excerpt :In addition, by implementing discharge goals for the recovery unit, (90 minutes for AS patients and 60 minutes for inpatients) nursing staff can appropriately prioritize care to achieve these discharge times.22-24 A QI strategy such as fast-tracking offers an evidence-based approach to discharge patients more efficiently, utilize existing staff more appropriately, and match outpatient facility benchmarks enabling the facility to offer comparable and competitive services.24 Data analysis showed that OR holds still occurred following fast-tracking implementation but patients who met PACU II criteria experienced shorter hold times.
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2018, Journal of Perianesthesia NursingCitation Excerpt :Our PACU nursing team documents reasons for delayed discharge, using a Pareto chart, on a weekly basis in an effort to monitor longer PACU stays and implement real-time strategies targeted at decreasing them. Our reasons for transfer delays are consistent with previous studies, although the percentages vary.10-12 Mather et al,10 for example, found that 41% of PACU transfer delays were because of PACU nurses being busy with another patient.
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2017, Journal of Perianesthesia NursingCitation Excerpt :Similar findings were found in an observational study that used a PACU score that showed no significant change in the average time a patient was in the PACU and that other causes of delay may have affected a patent's time in PACU, such as an organizational factor of patient transfer delay.14 This finding contrasts with that of Brown et al15 who, in their observational study, introduced a discharge criteria plan into their PACU and found that overall the time spent in PACU had decreased (24% reduction, P = .0), time spent waiting for nurse escort decreased (P = .0), and the multiple causes for discharge delay overall also decreased (P = .08). Importantly for patient safety, it was noted that there was a significant decrease in the number of patients arriving on the ward with unstable vital signs (P = .042).15
Design and Testing of a Postanesthesia Care Unit Readiness for Discharge Assessment Tool
2017, Journal of Perianesthesia NursingCitation Excerpt :Because of the time it took to assess patients using two different assessments tools and for two nurses to assess patients independently, 202 patients were included in the testing of the 10-item RDAT which is twice the number needed for an adequate sample size. The 10 items in the RDAT and their accompanying scoring criteria were developed from (1) the assessment/discharge criteria outlined by ASPAN standards and the American Society of Anesthesiologists,12 (2) criteria noted as important in the review the literature, and (3) criteria included in other published tools, and most notably by criteria described by Brown et al.11 The RDAT's 10 assessment criteria include activity, respirations, pulse, blood pressure, temperature, oxygen saturation, consciousness/mental status, pain, nausea, and surgical bleeding. The intent was to develop an assessment tool to determine patients' readiness for discharge using a rating method that weighted all criteria equally.