Today’s perioperative healthcare providers face a growing challenge: efficient capacity utilization. Frequent PACU backups and inability to discharge patients to an inpatient care unit creates bottlenecks and impedes patient care. It is essential to smooth operations. Nurse leaders must first understand the reasons for the backups.
● Are there not enough inpatient beds?
● Are surgeons scheduling inappropriate case volumes?
● Are there significant process and staffing issues?
Optimized patient throughput assures a healthy bottom line in a time where increasing patient demand for services is being met with limited physical resources.
When Do PACU Backups Occur?
PACU backups occur when patient recovery bays are fully occupied or there is insufficient staffing on the unit for the patient volume. This backup creates a risk of keeping patients in the operating rooms while waiting on an available PACU bed which creates costly delays in the OR schedule and increases the overall cost of patient care.
In some circumstances, inpatient bed availability may be the problem that needs to be addressed by inpatient care coordinators. Some innovative periop departments have developed alternative solutions by discharging from PACU to a Phase 2 Recovery Unit. In the Phase 2 Recovery Unit, patients are cared for at a lower staffing level and held until inpatient beds become available later in the day or evening. Arrangements can be made to start post-operative therapy or treatments on the Phase 2 Recovery Unit to support post-operative care standards. It also allows patients to be united with their family more quickly.
Successful Patient Throughput Requires Organizational Alignment
The procedure of discharging from the PACU needs to be closely managed as it is a continuum of many interrelated processes. Both the PACU Manager and Anesthesia Medical Director should be involved in making decisions to discharge patients from the PACU and to avoid PACU backups. Likewise, the PACU Manager works closely with the nursing staff to understand the solution and to plan for appropriate nurse to patient ratios for the patients on the Phase 2 units. In addition, the PACU Manager makes arrangements with other departments for post-operative therapy or treatments that will be initiated in the Phase 2 Recovery unit. The Anesthesia Medical Director would make the final decision on whether to hold the patient in PACU or move them to the Phase 2 Recovery unit. These holds should be reviewed by the perioperative governance group and become a vital measure of performance of the Anesthesia Medical Director and the department.
A Two-Pronged Approach to Improving Patient Throughput
If there are simply not enough inpatient beds available, develop alternative solutions. For example, many innovative departments have developed a Phase 2 Recovery Unit. This extra resource will decrease the nurse to patient ratios needed. On this unit, initial physical therapy and post-op treatments can commence. This reallocation of fixed resources allows more time in the day for inpatient units to discharge patients and make room for the post op patients.
The PACU Manager and Anesthesia Medical Director need to have closer oversite of PACU bed capacity to move patients to Phase 2 Recovery Unit or inpatient beds as clinically appropriate. Anesthesia Medical Directors must approve PACU holds, which should be one of their performance measures.
Interested in learning more on this topic? Read our recent blog post, ‘Six Elements of Patient Throughput.’
The Future of Inpatient Bed Capacity Management
Inpatient bed capacity management will continue to be a challenge for all hospitals. It is no longer acceptable to struggle with PACU holds because of the inability to transfer to inpatient beds. Proactive perioperative departments are discovering alternative solutions to avoid PACU holds or inevitable holds due to the inability to discharge patients.
A well-developed and well-executed patient throughput process will meet patient service expectations, surgeon needs, and reduce cost per case. For information about our optimization projects and how Sullivan Healthcare consultants can improve operational efficiency contact us today.
Randy Heiser is the President of Sullivan Healthcare Consulting. Randy has been a hospital consultant since 1983 and has specialized in perioperative consulting since 1992. He has directed more than 500 surgery department operational improvement studies (and participated in an additional 350) in programs ranging from small community hospitals and freestanding surgery centers to some of the largest university hospitals in the U.S. He was instrumental in the design, development and implementation of the Surgery Benchmark Program that has been used by more than 280 hospitals. He has also participated in the design of several proprietary surgery scheduling information systems currently available in North America.