Download Using Discharge Criteria to Improve Patient Flow in the Recovery

Using Discharge Criteria to Improve Patient
Flow in the Recovery Room
Team Membership:
Irwin Brown, D.O.
Elaine Fluder, RN, MSN
Kris Sawicki, RN, BSN
Bruce Kleinman, M.D.
W. Scott Jellish, M.D., PhD
Jeri Katsaros, RN
Loyola University Dept. of Anesthesiology
Post Anesthesia Recovery Room Nursing
Opportunity Statement and Desired Outcome
Currently, patient stay in the post anesthesia recovery
unit (PACU) room is often prolonged. This results in
unnecessary use of expensive PACU resources and
reduces the ability to move patients from the operating
room to PACU in a timely manner.
The goal of this project is to achieve significant
reductions in the the length of patient stay in the
PACU
Likely Causes for Delay of Discharge from PACU
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Lack of timely physician order
High variability in decision making about discharge readiness
Multiple clinicians involved in discharge decision
Lack of explicit discharge criteria
Lack of bed availability
PACU nursing and/or transportation personnel unavailable for
transfer
 Complications (i.e., hemodynamic instability, bleeding,
cardiac, neurologic event)
 Pain management
 Uncontrolled nausea and vomiting
Solutions Implemented
 Criteria were developed to allow nurses to discharge selected
patients from PACU without evaluation by a physician
 Patient population included:
•All adult non-emergent surgical cases
• General anesthesia with or without regional block
• Discharge to floor bed anticipated at time of PACU admit (pts
needing ICU were excluded)
 A policy for discharge per criteria was implemented
 Education for both physicians and nursing
Criteria Used for Assessment of Discharge Readiness
1
Moves all extremities as per pre-op status
2
Able to deep breathe/cough freely, Resp. 12-25/min. +/-20% of baseline, 02
saturation of 97% or greater RA_ or supplemental 02
3
Hemodynamic stability: HR 60-100 +/-10% of baseline – SR or same as pre-op
and B/P +/-20% of pre-op baseline – 2 consecutive readings 15 min. apart at
discharge
4
Orientated to person – Obeys simple commands
5.
Temp. 36C = 37.8C
6
VAS pain score of 4 or less
7
Urine output (.5-1cc/kg/hr) if Foley present
8
No intractable nausea/vomiting
9
No undue anxiety or agitation
10
No excess surgical bleeding
11
An anesthesiologist has reviewed all lab/tests obtained by anesthesiologist order
Results
PACU mean discharge time in the physician group was
was 133 minutes vs. 102 minutes for nurse
implementation of discharge criteria. This clearly
demonstrates that utilization of discharge per criteria
substantially reduces length of PACU stay – see chart.
Average PACU Time (min)
PACU LENGTH OF STAY
PHYSICIAN VS. NURSE DISCHARGE PER CRITERIA
180
160
140
Mean = 130.6
120
Mean = 101.9
100
80
60
Discharge per physician
Nurse discharge per criteria
Conclusion
 Implementation of uniform discharge criteria has
significantly shortened patient stay in PACU.
Next Steps
 Implementation of PACU discharge criteria for all
patient populations.
 Address other causes of patient delay in discharge
from PACU.