ETCO2 Monitoring in High Risk Patients in the PACU: A Quality Improvement Project
Helen TaylorNancy AntinJulie GrandstrandStacy JepsenSue SendelbachDonna S. JohnsonGreg VeenendaalLori ReilandGreg Morrissette
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Background Operating room (OR) and post‐anesthesia care unit (PACU) activity are closely linked since the number, type, and sequence of surgeries influence subsequent PACU activity. We aimed to explore the relationship between duration‐of‐surgery (DOS) and PACU length‐of‐stay (LOS), the PACU‐LOS:DOS ratio, since it is among the determinants of the number of PACU beds and nurse staffing required to insure efficient egress of patients from the OR. Methods PACU‐LOS:DOS ratio was examined using retrospective data from a tertiary medical center's surgical information system (Phase 1) and prospectively collected data from a convenience sample of post‐operative patients (Phase 2). Results Phase 1 included 17 047 patients, the majority (73%) with PACU‐LOS:DOS ratios >1.0, indicating PACU‐LOS longer than DOS. Median PACU‐LOS was 117 minutes, median DOS was 80 minutes, and median PACU‐LOS/DOS ratio was 1.5. PACU‐LOS showed greater variability than DOS because of extended PACU stays. Phase 2 ( n = 2054) confirmed Phase 1 results (median PACU‐LOS/DOS ratio ‐ 1.8). In both phases at a DOS of >130 minutes PACU‐LOS/DOS ratio became <1.0. In 24% of Phase 2 patients PACU‐LOS was prolonged because of administrative issues. Post‐operative, more than pre‐ and intra‐operative, measurements influenced PACU‐LOS. Conclusions The PACU‐LOS/DOS ratio proved useful for demonstrating interactions between 2 central components of the surgical system. The many patients with PACU‐LOS:DOS ratios >1.0 provides objective evidence for the number of PACU beds exceeding the number of ORs.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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Postanesthesia care unit (PACU) monitoring reduces morbidity and is the standard of care for postsurgical patients.PACUs require large nurse to patient ratios, which contributes to the cost of care. Despite the importance and cost of PACU length of stay (LOS), no standards have been established. We performed an observational study of 340 PACU patients to measure actual and medically appropriate PACU LOS (the time required to achieve a medically stable condition for safe PACU discharge), to identify factors related to LOS, and to create a LOS prediction index. Mean (+/- SD) actual LOS was 95 +/- 43 min, and appropriate PACU LOS was 71 +/- 37 min. Appropriate PACU LOS predictors were anesthetic time, anesthetic technique, and amount of intraoperative fluids. Actual LOS was >30 min longer than the medically appropriate LOS for 20% (68 of 340) of the patients. Frequent causes of excessive LOS were waiting for physician release or laboratory or radiographic results. Appropriate LOS may be related primarily to anesthetic factors, and nonmedical issues account for a significant amount of PACU LOS. Implications: Most patients are stabilized immediately after surgery in a postanesthesia care unit (PACU) until their discharge to a hospital ward. However, there are no standards for appropriate PACU length of stay (LOS). In this study, we measured actual and appropriate PACU LOSs and evaluated clinical factors that may influence PACU LOS. (Anesth Analg 1998;87:628-33)
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Objective To investigate patients admitted to PACU within 4 years and evaluate the influential factors on duration stayed in PACU.Methods Data were collected prospectively from 2007 patients admitted to PACU.Factors of patients(reason of entering PACU,gender,age,anesthesia methods,with or without intratracheal duct)were determined.Then the relationship between above factors and PACU stay were studied.Results All patients in our PACU recovered stablely and safely.The mean PACU stay time was(65.84±38.69)min.Gender and anesthesia methods didn't effect the PACU staying time(P0.05).However,the age,with or without intratracheal duct and reasons of entering PACU contribute to staying time significantly(P0.01).Conclusion Patients who were elder,with intratracheal duct and enduring poor circulation or respireatory condition show longer staying time than the others.
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Postanesthesia care unit (PACU) monitoring reduces morbidity and is the standard of care for postsurgical patients.PACUs require large nurse to patient ratios, which contributes to the cost of care. Despite the importance and cost of PACU length of stay (LOS), no standards have been established. We performed an observational study of 340 PACU patients to measure actual and medically appropriate PACU LOS (the time required to achieve a medically stable condition for safe PACU discharge), to identify factors related to LOS, and to create a LOS prediction index. Mean (+/- SD) actual LOS was 95 +/- 43 min, and appropriate PACU LOS was 71 +/- 37 min. Appropriate PACU LOS predictors were anesthetic time, anesthetic technique, and amount of intraoperative fluids. Actual LOS was >30 min longer than the medically appropriate LOS for 20% (68 of 340) of the patients. Frequent causes of excessive LOS were waiting for physician release or laboratory or radiographic results. Appropriate LOS may be related primarily to anesthetic factors, and nonmedical issues account for a significant amount of PACU LOS. Implications: Most patients are stabilized immediately after surgery in a postanesthesia care unit (PACU) until their discharge to a hospital ward. However, there are no standards for appropriate PACU length of stay (LOS). In this study, we measured actual and appropriate PACU LOSs and evaluated clinical factors that may influence PACU LOS. (Anesth Analg 1998;87:628-33)
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