Archive Anesthesia 2018

On the Fast Track

6 keys to shorter stays in the recovery room.

Andi Rice

Andi Rice, DNP, CRNA


TRAFFIC JAM A crowded, congested recovery room will delay patient discharge.

If it's always rush hour in your recovery room, stretchers stacked and packed in every bay, the backup sometimes so bad that you have to hold post-op patients in the OR until a spot opens up, then you suffer from delayed PACU discharge.

I've seen patients stuck in PACU gridlock for 2 hours or more (I'd hate to see those satisfaction surveys!). And I've seen surgeons breeze through their first few cases of the day, only to see their operating room become a makeshift recovery room when the PACU is full. "OR holds" delay the start of every case thereafter and frustrate not only your surgeons and anesthesia providers, but also your nurses, your patients and, of course, you.

The good news: You can ease the congestion if you practice fast-tracking, the art of safely moving eligible ambulatory surgery patients through PACU as efficiently as possible and the science of assessing patients as they emerge from anesthesia to determine their eligibility for rapid discharge.

The most likely causes of delayed discharge are uncontrolled pain and nausea. If you were to ask patients what they're least looking forward to, it's not the incision or the surgery. It's the anticipated pain and the possibility of throwing up afterward. Surgeons can also inadvertently delay discharge. Patients have finished their ginger ale and crackers, and they're ready to go home but where's the surgeon? He's in the OR doing his next case or dictating the previous case — everywhere but in PACU signing the discharge order and writing prescriptions.

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