Defining the Criteria for PACU lengths of Stay

[dantespikiks]

Good day everyone,

I'm currently the Acting Unit Coordinator for my hospitals PACU, this year we've decided to seek ways to minimize patients lengths of sty in the unit a sour performance improvement plan. However, being in a third world country, our standards for care are radically different from the more advanced countries out there. In my unit we use the Aldrete Scale to assess PACU recovery, we're transitioning to using the RASS in place of the Modified Ramsay Scale, and we're using spinal dermatomes and the bromage scale to assess the recovery of neuraxial blocks.

One problem we occasionally encounter, especially in foreign patients, is that they complain why it takes so long for them to be transferred back to the ward. I've read about how patients generally stay in the PACU for less than 2 hours, being transported to the ward as soon as they are stable. In my latest census, for the past year, only 30% of patients stayed for less than 2 hours, most of them stayed between 2-6 hours, and we have a couple of boarders staying beyond 8 hours. most of our patients staying beyond 8 hours are either post-General anesthesia patients who have yet to wake up, or post neuraxial block patients whose dermatome and motor levels have not recovered fully yet.

I'm just curious whether the practice is internationally mandated that these patients need to stay in the unit for that long or is it fine to send them back to the ward as soon as there are signs of recovery?

Any input would be great, thanks!

[Goose Xx, MSN, RN, EMT-P, CRNA]

Without casting stones, it sounds like your patients may be over anesthetized. When I roll one of my patients into PACU, that are usually awake or at least arousable after general anesthesia; or able to at least wiggle toes or have some gross motor movement back.

Being a third world country, you use what you have available. I have several options available for every case that allow me to best time my anesthetic for short PACU times.

[dantespikiks]

thanks for the feedback!