Does your PACU hold ICU patients?

[DVB, BSN, RN]

Prior to COVID, do PACU nurses hold as ICU overflow in your PACU?  We are a Level II trauma, so we are not required to staff 24 hours.  Just wondering as prior to COVID we were holding ICU patients and the expectation became that the call person stayed with this patient until an ICU bed was available.  Is this a thing in all PACU?  Or just us? Any answers would be greatly appreciated.  Thankyou

[Corey Narry, MSN, RN, NP]

We do that at our medical center.  ICU beds can get tight so some ICU-bound patients do stay in the PACU sometimes until a bed opens up.  In those cases, we ICU providers are informed that the patient is in the PACU and we have to manage them and are first call for any issues nurses are having. There are exceptions of course...cardiac surgery including heart and lung transplants, liver transplants, simultaneous kidney-pancreas transplants, craniotomies, etc must go directly to the specialized ICU's because their care would be too complicated for PACU nurses. 

[Rose_Queen, BSN, MSN, RN]

Heck, lately PACU has been the open code bed because all of the critical care beds are filled. We have been evaluating bed availability for surgical patients who need inpatient stays, and several of them were either held until an ICU discharge took place or cancelled outright. We are level 2 trauma but do staff 24/7 with additional on call. 

[speedynurse, ADN, BSN, RN, EMT-P]

Yes, we hold med surg up to ICU patients in our PACU.....however, it is still better than walking into an ER full of holds!

[firewifeRN]

Yes we do! I work at a level 1 trauma center and we get ICU all the time. We have rotating shifts as well during the week so we only take call on weekends because of this. Usually every third weekend and it is only 12 hour shifts so 2 nurses will do 7a-7p and another 2 nurses will do 7p-7a on Saturday/Sunday only. 

[jnewcomb1026]

Our facility is doing this now due to lack of beds/staffing with influx covid patients taking up the majority of ICU/IMCU beds. We staff the unit 24/7  with a call team that rotate weekly call. Since covid has ramped back up, we are not only holding our post surgical patients that need ICU beds, but accepting transfers from the ICU if another patient from ER or the floor needs that bed. We aren't taking covid holds, but anything else goes. Nights aren't as bad since we don't run a full schedule overnight,  just emergent surgeries, but during the day, the pacu nurses are recovering a full surgery schedule plus add ons, and taking admissions and discharges to and from surgical and ICU. It's a lot for our little department, and we usually staff 5 rns for 60 some cases during the day..which is a stretch but doable if we don't have 2 of those nurses tied up with CCU patients and holds. We only have 12 bays so I question where they plan to put patients if the surgery schedule stays up. It's a constant battle. Now the call team is no longer "on call" but we are required to staff the units that are short staffed and be on call to the PACU for admissions and the regular surgeries that come through. Not to mention the schedule we work now has built in mandatory overtime with no end in sight. I hear traveller's are coming but our unit isn't getting any. Are other smaller places utilizing their PACU in this way? At times it feels like a dump.