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Post-Anesthesia Care Unit reduces delays by 80 per cent

Toronto, August 7, 2013

By Emily Holton

PACU registered nurses Inmyong Nahm and Bernadette Halloran review the day’s surgery cases.
PACU registered nurses Inmyong Nahm and Bernadette Halloran review the day’s surgery cases. (Photo by Yuri Markarov, Medical Media)

After weeks or months of waiting for a slot in the OR, the time finally comes for a patient’s surgery.

He or she books time off of work, arranges for a ride to and from the hospital as well as help recovering at home, abstains from food and water for hours and prepares mentally and emotionally for what’s to come… and then their surgery is cancelled at the last minute.

What’s happened? If no beds are available in the Post-Anesthesia Care Unit, the area where patients are taken directly after surgery, patients must recover in the OR. This creates a backlog in the OR, delaying the next surgery. If delays accumulate throughout the day, that sometimes means that the last surgery of the day must be cancelled.

In February, Meredith Muscat (CLM in Perioperative Services) and her team sat down to figure out how to avoid delays in PACU.

“Preventing cancellations was our major concern, but we also didn’t want our patients waking up after surgery still in the OR,” said Muscat. “Neither are good experiences for our patients. So we looked at how patients flow through our services and made some changes that have turned out to be really successful.”

The team rearranged some supplies and equipment and filled staff vacancies. But the key was reevaluating the flow of patients between the Ambulatory and main PACUs.

Muscat and her team changed their approach so that day surgery patients can go directly to the Ambulatory PACU, where patients recover more quickly. Then they move onto the Day Surgery Unit to be discharged home. Admitted patients continue to go to the main PACU and then on to inpatient units.

One month after this new process was implemented, surgery delays dropped by 80 per cent compared to 2012. The success has continued: April had 77 per cent fewer delays than the year before, and May had 69 per cent fewer delays.

About St. Michael’s Hospital

St Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.