Post-Operative Craniotomy Pathway - PACU to Floor Pilot

Background Information • Patients undergoing supratentorial craniotomy routinely progress from OR → ICU → Intermediate care → home • Eighty percent of patients are stable and ready for discharge to home the next day • ICU care adds one extra day and multiple care team hand-offs • Delayed throughput for outside hospital transfers and ED admissions secondary to ICU census • Increased OR holds Objectives of Project • Establish inclusion criteria to identify patients who can safely bypass the ICU and receive ICU level care in PACU prior to discharge to floor • Improve patient safety by reducing number of transfers of care from 3 teams to 2 teams • Improve patient experience by reducing overall hospital stay (goal 24 hours) • Decrease length of stay (LOS) • Improve utilization of ICU resources • Decrease OR hold time and delayed hospital throughput due to ICU bed availability • Lower cost of neurosurgical care delivery and optimize health care value for neurosurgical patients Process of Implementation • Multidisciplinary collaboration including: Neurosurgery, Nursing Leadership, ICU, PACU, and Neurosurgical Floor Nursing • Patients potentially eligible for the POC-PACU Pathway are identified prior to surgery • Information regarding patient enrollment in the pathway is communicated to relevant parties including flow managers, PACU charge nurse, and admitting via shared calendar • Development of PACU protocol care standards including escalation criteria • Staff education through multiple in-services, newsletter communication, and at the elbow support Statement of Successful Practice • All enrolled pilot patients (n=11) successfully discharged from PACU to floor • All enrolled pilot patients successfully discharged from floor to home the next day • Improved patient experience and decreased LOS • Improved ICU utilization and decrease in care team hand-offs Implications for Advancing the Practice of Perianesthesia Nursing • Pilot was successful and program expanded to include multiple neurosurgeons • Improved PACU staff confidence and competency in caring for the postoperative craniotomy population • Improve hospital throughput