your surgeons and anesthesia providers, but also your nurses, your
patients and, of course, you.
The good news: You can ease the congestion if you practice fast-
tracking, the art of safely moving eligible ambulatory surgery patients
through PACU as efficiently as possible and the science of assessing
patients as they emerge from anesthesia to determine their eligibility
for rapid discharge.
The most likely causes of delayed discharge are uncontrolled pain
and nausea. If you were to ask patients what they're least looking
forward to, it's not the incision or the surgery. It's the anticipated
pain and the possibility of throwing up afterward.
Surgeons can also inadvertently delay discharge. Patients have fin-
ished their ginger ale and crackers, and they're ready to go home …
but where's the surgeon? He's in the OR doing his next case or dictat-
ing the previous case — everywhere but in PACU signing the discharge
order and writing prescriptions.
On average, patients should spend around 60 minutes in PACU in an
ambulatory surgery center and 90 minutes in a hospital setting.
Whatever's causing the discharge delay in your PACU, focus on what
you can do to safely speed patients through recovery from the time
the OR notifies PACU of an incoming patient to discharge. How are
your providers anesthetizing patients — fast on, fast off is the goal
(see "New Spinal Anesthetic Wears Off (Very) Fast" on p. 34) — and
how are they treating pain and nausea? These factors and more can
delay discharge by 30 to 60 minutes ... or more.
Can you learn to fast-track?
Can you teach a facility to fast-track? To find out, my fellow
researchers and I put our theory to the test at Duke Regional Hospital
in Durham, N.C., a 369-bed acute care facility with 18 ORs, 10 PACU
5 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 8
