OR patients bypass PACU for ICU - page 3

by fedupnurse 11,477 Views | 28 Comments

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... Read More


  1. 0
    Quote from TypicalFish
    Think Narcan; reversal-bringing pt. out of the anesthesia necessary for surgery, something usually done in PACU. In my ACCU, we see extremely critical patients, and sometimes overflow come directly to the ACCU. Usually they are patients that can not be immediately extubated.

    Narcan is used only rarely in my community hospital anesthesia practice. We don't "reverse" the anesthesia. Its all a matter if timing. The only patients that we send directly to the ICU are patients that are intubated because our PACU nurses are not ICU nurses. If we didn't sedate the patient for the transfer from the OR to the ICU they would be talking to you by the time they got off the elevator. By the time the intubated patient arrived to ICU we're already talking about what we're going to use for sedation because the drugs we use in the OR are so short acting. We're a 150 bed community hospital.
  2. 0
    At the trauma center the liver transplants go to TICU and sometimes the CABG patients will go straight to CTICU. Any other vented patient comes to PACU and is monitored for a short time. At the trauma center, sometimes the vent patients are held in PACU because of lack of ICU/CCU beds. At my previous facility the vent patients came to PACU and usually stayed for about one[1] hour, primarily because the SCU nurses were too spoiled (I know it isn't nice but in this instance it was true) and the fellow didn't want to be bothered. However, if the patient had not come out of the OR before PACU closed (they did not run a 24/7 PACU. Closing was at 12 midnite, so anything from 1130 on was pushing the envelope) they went to SCU to be recovered, vented or not. Of course it was always a fight to get the patient there. On rare ocassion, a vented patient went straight to SCU but that was if the patient was having tremendous problems intraop. I do, however, agree that if a nurse is going to be recoving a patient, no matter where they are going, the staff on that floor should have some sort of PACU training. If staff are having to recover fresh post-op patients and they are not comfortable, they should be contacting their nurse manager, the nursing supervisor and if they are unionized, file an unsafe staffing report to protect themselves and then request training from Staff Developement. There is no replacement for proper training and education to maintain safe patient care and nursing practice.
  3. 0
    Our burn patients all go straight back. Also any stable unit pt that came to OR already intubated can return straight back as well. Obviously any pts. that require stabilization post-op do come to us at the discresion of Anethesia.
  4. 0
    None of our ICU patients go to PACU, there's really no need for it. The unit has all of the equipment that the PACU has and is equipped to deal with any emergencies that may arise.
  5. 0
    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
  6. 0
    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.
  7. 0
    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...
  8. 0
    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?
  9. 0
    Quote from 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...
    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.


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