title: Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery.
abstract: BACKGROUND
  Postoperative day-case patients are usually allowed to recover from anaesthesia in a postanaesthesia care unit (PACU) before transfer back to the day surgical unit (DSU). Bypassing the PACU can decrease recovery time after day surgery. Cost savings may result from a reduced nursing workload associated with the decreased recovery time. This study was designed to evaluate the effects of bypassing the PACU on patient recovery time and nursing workload and costs.
  
  
  METHODS
  Two hundred and seven consenting outpatients undergoing day surgery procedures were enrolled. Anaesthesia was induced and maintained with a standardized technique and the electroencephalographic bispectral index was monitored and maintained at 40-60 during anaesthetic maintenance. At the end of surgery, patients were randomly assigned to either a routine or fast-tracking (FT) group. Patients in the FT group were transferred from the operating room to the DSU (i.e. bypassing the PACU) if they achieved the FT criteria. All other patients were transferred to the PACU and then to the DSU. Nursing workload was evaluated using a patient care hour chart based on the type and frequency of nursing interventions in the PACU and DSU. A cost associated with the nursing workload was calculated.
  
  
  RESULTS
  The overall time from end of anaesthesia to discharge home was significantly decreased in the fast-tracking group. However, overall patient care hours and costs were similar in the two recovery groups.
  
  
  CONCLUSIONS
  Bypassing the PACU after these short outpatient procedures significantly decreases recovery time without compromising patient satisfaction. However, the overall nursing workload and the associated cost were not significantly affected.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital and Nursing Information Systems, Toronto General Hospital, University Health Network, University of Toronto, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Song
authors.forename: F
authors.initials: F
authors.lastname: Chung
authors.forename: M
authors.initials: M
authors.lastname: Ronayne
authors.forename: B
authors.initials: B
authors.lastname: Ward
authors.forename: S
authors.initials: S
authors.lastname: Yogendran
authors.forename: C
authors.initials: C
authors.lastname: Sibbick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000762:Anesthesia Recovery Period; D015400:Clinical Nursing Research; D004569:Electroencephalography; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009864:Ontario; D016528:Postanesthesia Nursing / Q000191:economics / Q000458:organization & administration*; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D011997:Recovery Room; D016526:Workload