Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms.
The authors performed a systematic review of strategies to reduce delays in admission into PACUs from ORs. The purpose of this article was to evaluate for managers how to choose interventions based on effectiveness and practicality. The authors discuss optimization methods that can be used to sequence consecutive cases in the same OR, by the same surgeon, on the same day, based on the objective of reducing delays in PACU admission due to the unavailability of unfilled PACU beds. Although effective, such methods can be impractical because of large organizational change required and limited equipment or personnel availability. When all physical beds are not full, PACU nurse staffing can be adjusted. Statistical methods can be used to ensure that nursing schedules closely match the times that minimize delays in PACU admission. These methods are effective and practical. Explicit criteria can be applied to assist in deciding when to assign other qualified nurses to the PACU, when to ask PACU nurses to work late, and/or when to make a decision on the day before surgery to add more PACU nurses for the next day (if available). The latter would be based on statistical forecasts of the timing of patients' admissions into the PACU. Whether or not all physical beds are full, the risk of delays in PACU admission is relatively insensitive to economically feasible reductions in PACU length of stay. Such interventions should be considered only if statistical analysis, performed by using computer simulation, has established that reducing PACU length of stay will reduce delays in admission at a manager's facility.
Dexter
Franklin
F
Division of Management Consulting, University of Iowa, Iowa City 52242, USA. franklin-dexter@uiowa.edu
Epstein
Richard H
RH
Marcon
Eric
E
de Matta
Renato
R
D000465:Algorithms; D001071:Appointments and Schedules; D017598:Efficiency, Organizational; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D015274:Interdepartmental Relations; D007902:Length of Stay / Q000706:statistics & numerical data*; D020380:Needs Assessment / Q000458:organization & administration; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D009873:Operating Rooms / Q000458:organization & administration*; D009937:Organizational Objectives; D010343:Patient Admission / Q000592:standards*; D019990:Perioperative Care / Q000451:nursing / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D016528:Postanesthesia Nursing / Q000458:organization & administration*; D011997:Recovery Room / Q000458:organization & administration*; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*; D016526:Workload