OR patients bypass PACU for ICU

[fedupnurse]

Just wondering if anyone else out there is seeing a trend toward patients who should go to the PACU being sent to general ICU's directly from the OR instead? This is a common practice for our open heart ICU and the staff of that unit receives extensive training to safely provide this type of care. They also have 1:1 staffing. Our general Medical and Cardiac ICU's generally have 2 to 3 patients per nurse and we are not trained to care for surgical ICU patients (but often get their overflow). We are also not trained in anesthesia reversal. Any thoughts or input would be greatly appreciated!!

[debthern]

If the patients came from the icu they go directly back there if they came through the er or from outpatient they come to us and then we take them to icu when they are stable

[JenICURN]

We're having more and more pts come straight from the OR, especially at night--they'd rather send them to us than staff the PACU adequately! Annoying and a danger to pts, especially since these patients are rarely 1:1.

[Ortho_RN]

We send patients straight up to ICU if they are going to be on vent... No point in wasting time moving the patient and the vent twice... Nothing to recover when they are on a vent...

[kcmagu]

In our ICU, most patients that are going to stay on the vent come directly to ICU from OR, so does any major surgical trauma pt and any patient going to the or that was already an icu pt. they are not 1:1's - except for the open hearts. Is anyone aware of any literature on recovering pts in the icu?

[NurseSnarky]

We send patients straight up to ICU if they are going to be on vent... No point in wasting time moving the patient and the vent twice... Nothing to recover when they are on a vent...

Same here...and I fought a year and a half for this change in our hospital. I worked in a bigger facility and then came to this small hospital. NO ONE wanted to stand up and make changes. I didn't see the point in moving RT twice, bagging the patient twice, and all of this disruption when the ICU staff were perfectly capable of recovering. The new ICU manager thankfully came from a big city hospital where that's how it was done and she agreed...the docs wanted it done that way too...so it finally was changed. I will go over and help if I have time and they need me, but they can handle it. It actually was the OR nurses who felt uncomfortable about it all...they felt they were dumping on the ICU nurses! And us PACU nurses were "getting out recovering". It finally all fell into place and now it all goes smoothly. It's the right thing to do for the patient. In our hospital there are only two PACU nurses and many more ICU nurses.