Obstetric postanesthesia care unit stays: reevaluation of discharge criteria after regional anesthesia.
BACKGROUND
Obstetric patients may have long postanesthesia care unit (OB-PACU) stays after surgery because of residual regional block or other conditions. This study evaluated whether modified discharge criteria might allow for earlier discharge without compromising patient safety.


METHODS
Data were prospectively collected for 6 months for all patients (N=358) who underwent cesarean section or tubal ligation and recovered in the OB-PACU. Regional anesthesia was used in 94% of patients. The duration of anesthesia and PACU stays, the presence and treatment of events in the PACU, and the regression of neural blockade were recorded. Discharge from the OB-PACU required a 60-min minimum stay, stable vital signs, adequate analgesia, and ability to flex the knees. After completion of prospective data collection, events that kept patients in the PACU after 60 min were reevaluated as to whether patients needed to stay in the PACU for medical reasons. "Needed to stay" events included bleeding, cardiorespiratory problems, sedation, dizziness, and pain. "Safe to leave" conditions included pruritus, nausea, and residual neural blockade. The cumulative duration of OB-PACU stays not clearly justifiable for medical reasons was calculated.


RESULTS
Residual block and spinal opioid side effects accounted for the majority of "unnecessary" stays. Annually, 429 h of PACU time could have been saved using the revised criteria. Complications did not develop subsequently in any patient deemed "safe to leave."


CONCLUSIONS
In many obstetric patients, the duration of PACU stays could safely be shortened by continuing observation in a lower-acuity setting. This may result in greater flexibility and more efficient use of nursing personnel.
Cohen
S E
SE
Department of Anesthesia, Stanford University School of Medicine, California 94305-5640, USA. secohen@leland.stanford.edu
Hamilton
C L
CL
Riley
E T
ET
Walker
D S
DS
Macario
A
A
Halpern
J W
JW
D000328:Adult; D000762:Anesthesia Recovery Period; D000773:Anesthesia, Obstetrical / Q000191:economics*; D002585:Cesarean Section; D017046:Cost Savings; D005260:Female; D006757:Hospital Units / Q000191:economics*; D006801:Humans; D016528:Postanesthesia Nursing / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics; D011247:Pregnancy; D011446:Prospective Studies; D013246:Sterilization, Tubal; D013997:Time Factors