title: Financial and operational impact of a direct-from-PACU discharge pathway for laparoscopic cholecystectomy patients.
abstract: BACKGROUND
  We assessed the operational and financial impact of discharging laparoscopic cholecystectomy (LC) patients directly from the postanesthetic care unit (PACU) in comparison with post-transfer discharge from a hospital bed in a busy academic hospital.
  
  
  METHODS
  We retrospectively compared 6 months of performance (bed utilization; recovery room and hospital length of stay; complications; readmissions; hospital costs, revenue, and margin) after implementation of PACU discharges (case patients) to the corresponding 6 months in the prior year (control patients).
  
  
  RESULTS
  After implementation, 66% of LC case patients were discharged on the day of surgery, compared with 29% in the control group (P < .05). Eighty percent of the day-of-surgery discharges were directly from the PACU. Shifting to PACU discharge saved 1 in-hospital bed transfer and 1 bed-day for each PACU discharge. Recovery room length of stay for PACU discharge patients was 26% longer than for hospital discharge patients (P = NS). Average hospital length of stay for all patients discharged on the day of surgery was 3.2 hours shorter (P < .05) for case patients (80% PACU discharge) than for control patients. There were no readmissions in the PACU discharge group and no difference in complications. While costs, revenue, and net margin for PACU discharge patients were reduced by 40% to 50% (P < .02) relative to floor discharge patients, the hospital's net margin for the combined case patient group was preserved relative to the control group.
  
  
  CONCLUSIONS
  PACU discharge of LC patients significantly reduces bed utilization, decreases in-hospital transfers, and allows congested hospitals to better accommodate patient care needs and generate additional revenue.
authors.affiliation: Harvard Medical School and the Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Mass 02114, USA.
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.forename: Timothy
authors.initials: T
authors.lastname: Canty
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Sokal
authors.forename: Bethany
authors.initials: B
authors.lastname: Daily
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D001509:Bed Occupancy / Q000191:economics / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics* / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D016528:Postanesthesia Nursing / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D011997:Recovery Room / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies