PACU overflow patients

[Windy B.]

Our PACU is one of the many around the country that is experiencing problems getting rooms for our post op med-surg patients and end up keeping them for hours to days. We are setting up a Level III (Boarder Unit) and would like to know what other PACUs are doing. Have you drawn up policies and procedures to cover the care of these patients. How do you staff it for the overnight 'boarders'? Do you have a special crew of nurses just to take care of them or do you cover it with call staff?

Any help you can give would be greatly appreciated.

[mattsmom81]

So far the way it has been dealt with is to pull staff from other units to manage the longer term 'boarders'. Since PACU has its own computerized charting system which is seperate from the rest of the hospital's, these patients have paper documentation.

I am an ICU nurse and sometimes I will be pulled to PACU to manage a patient there, just like in ER. It can be a problem as we don't have the setup for longterm patient care, so we do the best we can.

I think definite policies are a good idea: so far we do not have them but I can see them coming. Hospitals are often full to the brim with nowhere to put patients.

[seeley]

We are exeriencing this problem in the PACU where I currently work...we were experiencing that problem in the PACU where I worked before my current employer. It seems to be a problem that is not going to go away. The US population is growing, also living longer and the acuity of care for this aging population is rising...they are sicker than the elderly were even 20 years ago.

The demand for health care is rising rapidly. Our hospitals are bursting at the seams. ERs and PACUs have perpetual boarders.

Management has fine tuned the capacity of hospitals so that for the most part they are all 100% full (or close to it) most every day here in the state of Maryland.

There is no good solution for boaders in the PACU as far as I can see. Patients don't like it and families don't like it...there is no privacy and they are exposed to the ongoing stress of the work of the PACU as the patient is long past PhaseI recovery and into PhaseII...completely aware of his/her surroundings and longs for a private room.

The best thing you can do is try to cohort the boarders together in the PACU as far away from the sickest patients that you will be continuing to recover. Pull the curtains so they at least can't see everything going on about them. Let them have visitors and try to remember that it is stressful for them to be there long after they should have been transferred out to a private room.

[ativanni]

Our PACU has patients over night. Every night. Anywhere from 2 to 8!

We wish we had a BOARDER unit! It is impossible to provide for the needs of these parked patients in addition to immediate post ops.

I would like to know how you handle ratios in these cases?

We have both adults and peds and any level of care! ICU to floor.

We staff nights and weekends.

[LandDRN]

I don't work PACU anymore but when I did we had these "boarders" and unfortunately we had to take nighttime call to care for these pts. It would not be unusual to work 2 18hr shifts a week due to this.