Analyses of the phase I postanesthesia care unit baseline capacity and effect of disruptions to its beds or nurse availability on operating room workflow

Khorasanian, Danial; Dexter, Franklin; Moslehi, Ghasem

doi:10.1504/ijps.2018.095441

Cited by 4 publications

(6 citation statements)

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“…Postoperative recovery times, defined as the end of surgery until leaving for the surgical ward, were compared between the hospitals. Results The median [interquartile range] of recovery times was 112 min at the University of Iowa and 22 [18][19][20][21][22][23][24][25][26][27][28][29] min at the Shin-yurigaoka General Hospital. Every studied patient at the University of Iowa had a longer recovery time than every such patient at Shinyurigaoka General Hospital (Wilcoxon-Mann-Whitney, P \ 0.001).…”

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confidence: 99%

“…Le temps de récupération postopératoire, défini comme étant le délai écoulé entre la fin de l'intervention et le départ pour l'unité de chirurgie a été comparé entre les 2 hô pitaux. Résultats La valeur médiane [plage interquartile] du temps de récupération a été de 112 [94-140] minutes à l'université de l'Iowa et de 22 [18][19][20][21][22][23][24][25][26][27][28][29] minutes à l'hô pital général Shin-yurigaoka. Toutes les patientes étudiées à l'université de l'Iowa ont eu un temps de récupération plus long que chacune des patientes de l'hô pital général Shinyurigaoka (test de Wilcoxon-Mann-Whitney, P\0,001).…”

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Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study

Thenuwara

Yoshimura²,

Nakata

et al. 2018

Can J Anesth/J Can Anesth

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This knowledge can be generally applied in situations at hospitals with regular PACU use when there are such large disruptions to PACU capacity that it is known before a case begins that the anesthesiologist likely will need to recover the patient (i.e., when there will not be an available PACU bed and/or nurse). The Japanese anesthesiologists have no PACU labour costs but likely greater anesthesia drug/monitor costs.

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confidence: 99%

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Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study

Thenuwara

Yoshimura²,

Nakata

et al. 2018

Can J Anesth/J Can Anesth

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“…Other applications of our results are when portions of the PACU are unavailable, so some patient recovery will be in the OR (eg, flood, closed for renovations, or few nurses). [11][12][13][14][15][16][17]31 Limitations Systematic assessments of patients before discharge to the hospital wards were limited to pain level. However, our results match recovery times from decrement times for inhaled anesthetics.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Comparison of Percentage Prolonged Times to Tracheal Extubation Between a Japanese Teaching Hospital and One in the United States, Without and With a Phase I Postanesthesia Care Unit

Sugiyama

Dexter

Thenuwara

et al. 2020

Anesthesia &Amp; Analgesia

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BACKGROUND: Prolonged times to tracheal extubation are those from end of surgery (dressing on the patient) to extubation 15 minutes or longer. They are so long that others in the operating room (OR) generally have exhausted whatever activities can be done. They cause delays in the starts of surgeons’ to-follow cases and are associated with longer duration workdays. Anesthesiologists rate them as being inferior quality. We compare prolonged times to extubation between a teaching hospital in the United States with a phase I postanesthesia care unit (PACU) and a teaching hospital in Japan without a PACU. Our report is especially important during the coronavirus disease 2019 (COVID-19) pandemic. Anesthesiologists with some patients undergoing general anesthetics and having initial PACU recovery in the ORs where they had surgery can learn from the Japanese anesthesiologists with all patients recovering in ORs. METHODS: The historical cohort study included all patients undergoing gynecological surgery at a US hospital (N = 785) or Japanese hospital (N = 699), with the time from OR entrance to end of surgery of at least 4 hours. RESULTS: The mean times from end of surgery to OR exit were slightly longer at the US hospital than at the Japanese hospital (mean difference 1.9 minutes, P < .0001). The mean from end of surgery to discharge to surgical ward at the US hospital also was longer (P < .0001), mean difference 2.2 hours. The sample standard deviations of times from end of surgery until tracheal extubation was 40 minutes for the US hospital versus 4 minutes at the Japanese hospital (P < .0001). Prolonged times to tracheal extubation were 39% of cases at the US hospital versus 6% at the Japanese hospital; relative risk 6.40, 99% confidence interval (CI), 4.28–9.56. Neither patient demographics, case characteristics, surgeon, anesthesiologist, nor anesthesia provider significantly revised the risk ratio. There were 39% of times to extubation that were prolonged among the patients receiving neither remifentanil nor desflurane (all such patients at the US hospital) versus 6% among the patients receiving both remifentanil and desflurane (all at the Japanese hospital). The relative risk 7.12 (99% CI, 4.59–11.05) was similar to that for the hospital groups. CONCLUSIONS: Differences in anesthetic practice can facilitate major differences in patient recovery soon after anesthesia, useful when the patient will recover initially in the OR or if the phase I PACU is expected to be unable to admit the patient.

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“…Importantly, the goal is not to report the numbers of patients or needed nurses, but to choose PACU nurse staffing with appropriate coverage by time of day. If there are N nurses and N shifts combinations of start times and scheduled hours worked, the number of different PACU staffing plans equals 21 ðN nurses þ N shifts À 1Þ!=ðN shifts À 1Þ! ðN nurses Þ!…”

Section: Influence Of Time-of-day Variation In Length Of Stay On Empimentioning

confidence: 99%

“…1), and assuming 28 PACU nurses potentially working 23 different shifts, there would be approximately 9 Â 10 13 different staffing plans. 21 The primary challenge in calculating PACU staffing is not to display needed staffing by the hour, but rather to use the data to choose the best possible plans from among the many billions of reasonable options.…”

Section: Influence Of Time-of-day Variation In Length Of Stay On Empimentioning

confidence: 99%

Implications of variation by time of day in post-anaesthesia care unit length of stay for rational nurse staffing

Dexter

Epstein

2018

British Journal of Anaesthesia

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Analyses of the phase I postanesthesia care unit baseline capacity and effect of disruptions to its beds or nurse availability on operating room workflow

Cited by 4 publications

References 0 publications

Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study

Time to recovery after general anesthesia at hospitals with and without a phase I post-anesthesia care unit: a historical cohort study

Comparison of Percentage Prolonged Times to Tracheal Extubation Between a Japanese Teaching Hospital and One in the United States, Without and With a Phase I Postanesthesia Care Unit

Implications of variation by time of day in post-anaesthesia care unit length of stay for rational nurse staffing

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