Just here wondering if anyone has had the same experience as me.
So I work in a small 5 bed PACU and my OR usually runs at LEAST 30 scheduled cases. On daily its a given we get a few add-on cases. Unfortunately my recovery also recovers c-sections before we transfer them to postpartum. My OR team and Anesthesia doesn't give a **** about us and bangs out cases quick. My pacu is royally screwed especially if we run 4 rooms. I find myself recovering patients for 30 minutes before sending them to out phase II (definitely not safe). Im pushing 50 hour weeks (not including call time). Anyone in this same situation ?
Nov 21, '12
Couple of thoughts:
First, how many ORs do you have? You should have at least 1.5x PACU beds to ORs, so unless you're only running 2-3 ORs, you need more PACU beds and staff. Also, why doesn't L&D recover their c-section patients? Every place I've worked, L&D had their own ORs and did their own recovery. Is that an option to explore?
Second, how is communication? Are you keeping the OR charge nurse and anesthesia aware of c-section patients that you are recovering? Are they communicating with you about surgeons running ahead of/behind schedule and when add ons are going to be started?
You'd be surprised by how much opening the lines of communication can do. Keeping the OR aware of PACU problems can help avoid the crunch of patient in OR needs to come out but nowhere to go with them (we usually run into issues with there being no beds to transfer patients to from PACU, and then they have to sit in PACU, which means unless they tell us they're out of beds, we sit with patients in the OR- if they tell us, we can hold surgeries). The OR notifying PACU of wanting to get an add on started can lead to conversation about only having enough beds to handle the scheduled cases already underway rather than just starting an add on and then not having anywhere to go when finished.
Nov 26, '12
You seem so angry and are taking it so personally. I assure you the OR team and anesthesia are simply thinking about doing their job efficiently and safely, staying on time, fitting in the unscheduled cases, and not having to stay for a lot of overtime. They are not trying to screw up your day.
Take a deep breath. Keep track of your typical day for a week or two. Take these facts to your manager, show her how often you had to send a patient to phase II after 30 minutes. Show her how many days you stayed overtime. Try to offer her solutions, not just "complaints."
I went from an acute care hospital based surgery center that used the phase I, phase II system, to a same day surgery center. I was surprised at first about no phase ! acute recovery time. However thousand of same day surgeries require less anesthesia, less acute care, Phase I level PACU nursing. Do all patients need to come to phase I? Just a "solution" to offer your manager.
Dec 5, '12
Are you getting Propofol MAC cases to to your PACU? Why can't they be admitted directly to your Phase II area?
Add on cases are going to happen. You can't change that. Look at other angles. Is bed assignments an issue? Do you have some RNs holding their patients despite the pt meeting discharge criteria?
It sounds like you're at a smaller facility and not doing huge cases....in a 5 bed PACU. What is the concern of having a patient in Phase I for 30 minutes before sending them to Phase II?
Is your caseload inpatient, same day admits, ambulatory?
Jan 12, '13
I feel for you. Sweet wild rose is dead right; 1.5 bays per theater is the optimum, which at least gives you adequate facilities and reduces the pressure on you to discharge your patients.
Yes, there are a few things you can do to reduce it further. If you are stuck for space, put the ORs on hold. If they want to argue the point, get the UM to do it. I find there's usually no problem though; they will clock the patient out once extubated and start the post-op observations until PACU is cleared. Ignore any moans and groans; it's normally only the lazy ones who do that - you know, the type who only see their own assigned tasks and feel horribly put upon if it goes somewhat over their own preset limits? They can't make too much noise, because they know patient safety is as much their responsibility as yours.
Jan 29, '13
I work at a large academic medical center and we are in a similar situation. We have 23 ORs and 20 PACU Bays. Our hospital is on red light so much of the time that we end up "boarding" patients and putting ORs on hold. We simply need more space and more staff...
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