Original articleImpact of Average Patient Acuity on Staffing of the Phase I PACU
Section snippets
Background
The number of nurses in the Phase I PACU should be chosen to ensure that the PACU meets staffing guidelines and accommodates all patients from the ORs on the majority of days (95%-99%). The frequency of delays must be balanced against the relative costs of an hour of OR time and an hour of PACU staffing. Prevention of all delays is not cost-effective and is virtually impossible to achieve without a large excess in the number of nurses staffing the PACU.
For smaller PACUs (ie, with less than 4
Patient Acuity
What the preceding section does not describe, and the existing literature does not consider, is how to incorporate patient acuity into the staffing plan. A recent article reported disturbing results that some PACUs may have staffing that is inadequate to care for existing patients, given their physiologic condition.4
According to the ASPAN guideline for Phase I PACU care,5 a minimum of two licensed nurses should be present at all times when patient care is provided, even if the number of
Example of PACU Staffing Optimization
A 28-OR facility had 205 staffed PACU hours per workday. A delay in PACU admission occurred on 59% of 96 consecutive workdays in 2004.
Nurses worked 8-, 10-, and 12-hour shifts starting at 6 am, 7 am, 8 am, 9 am, 10 am, 11 am, 12 pm, 1 pm, 3 pm, 4 pm, 9 pm, and 11 pm. A prospective survey of patient acuity was performed. Using the previous methods, average patient acuity was 1:1.77, representing a mixture of 1:1 and 1:2 patients.
The analysis described in the Background was performed using these
Conclusions
Because the total number of PACU nursing hours per day is limited by budget constraints, delays in admission from the OR cannot be eliminated entirely. PACU staffing can be adjusted so that 5% is the maximum percentage of days that the PACU is full and cannot accept additional patients from the OR. Optimal staffing options attempt to achieve this goal with a minimum of PACU nursing hours. Except for very small PACUs, these options cannot be determined manually because potential combinations of
Franklin Dexter, MD, PhD, is Director, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA, USA and Professor, Departments of Anesthesia and Health Management & Policy, University of Iowa, Iowa City, IA
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Cited by (34)
Balancing Workload in the PACU by Using an Integrated OR Planning Methodology
2021, Journal of Perianesthesia NursingCitation Excerpt :The data set included 29 variables containing relevant information regarding the monitoring of the surgery outline and the patient's stay in the PACU (Table 1). To increase the applicability of the proposed model for numerous health care institutions, uniform patient groups were derived by means of a prototype evaluation system in which group membership was dependent on the patient's priority indication, America Society of Anesthesiologists physical status classification, and planned surgery duration.16,17,18 Probability distribution fitting was performed to identify the stochastic distribution that was best suited to approximate the procedure times and length of stay (LOS) in the PACU for the identified uniform categories.
Opportunities to Improve the Capacity to Rescue: Intraoperative and Perioperative Tools
2020, Anesthesiology ClinicsCitation Excerpt :A variable patient census, fixed staffing models, and pressure to accept patients from the operating room may adversely affect staff/patient ratios and potentially reduce the ability to detect a single patient experiencing a rapid deterioration. More sophisticated staffing algorithms may improve PACU nurse/patient ratios.27 For example, when applied retrospectively, sophisticated computerized staffing models avoid underestimation of PACU staffing needs better than more conventional methods.28
Predicting daily surgical volume for an academic medical center
2020, Perioperative Care and Operating Room ManagementCitation Excerpt :In order to leverage the full benefit of having predictive volume estimates up to 4 weeks before the day of surgery, an updated approach to staff and resource planning will need to be adopted. In perianesthesia areas, a nurse manager may estimate expected patient acuity levels for a given day and time of day, use predicted volume estimates, and apply nationally recognized staffing ratios18 to obtain a reasonable estimate of required perianesnesthia staff.19 While the forecasted number of surgical cases may directly inform perianesthesia staffing levels, it does not directly inform OR staffing since staffing methods differ.
The Postanesthesia Care Unit and Beyond
2019, A Practice of Anesthesia for Infants and Children
Franklin Dexter, MD, PhD, is Director, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA, USA and Professor, Departments of Anesthesia and Health Management & Policy, University of Iowa, Iowa City, IA
Ruth E. Wachtel, PhD, MBA, is Associate Professor, Department of Anesthesia, University of Iowa, Iowa City, IA
Richard H. Epstein, MD, is Professor, Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, and President, Medical Data Applications, Ltd., Jenkintown, PA.
- 1
F.D. is Director of the Division of Management Consulting, which is a Division of the Department of Anesthesia at the University of Iowa. He receives no funds personally other than his salary from the State of Iowa, including no travel expenses or honoraria, and has tenure with no incentive program.
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R.H.E. is President of Medical Data Applications, Ltd., which developed the CalculatOR™ software that was used to perform one of the analyses described in this article.