Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery †

Abstract

Bypassing the PACU after these short outpatient procedures significantly decreases recovery time without compromising patient satisfaction. However, the overall nursing workload and the associated cost were not significantly affected.

A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients

“…This result is similar to published work from the adult literature. 8,9 The physiological scoring system used allows for assessment of a range of physiological parameters, including level of consciousness, respiration, hemodynamics, and postoperative outcomes, including bleeding from the surgical site. More than three-fourths of patients had a CBD time that was less than the corresponding TBD time, demonstrating the potential for the physiological scoring system to save time spent in the PACU.…”

“…The physiological score (maximum score, 14; Table 1) was a combination of the systems of Aldrete 8 and Chung 11 evaluating respiration, circulation, level of consciousness, and postoperative outcomes. Scores were recorded every 15 min starting upon arrival in the PACU.…”

“…7 A modified version has been used in a number of studies to fast-track ambulatory adult patients from the operating room to the ward or directly home, bypassing the PACU. 4,8,9 A more recent physiological scoring system, the PostAnesthetic Discharge Scoring System (PADDS), 10 and its modification 11 include an assessment of bleeding at the surgical site not seen in other scores.…”

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

“…27 Both Song and Williams et al have observed the phenomenon of an increased number of interventions in phase 2 recovery. 8,28 They have recognized that shortening phase 1 recovery time simply transfers the workload to phase 2 recovery; however, the extra interventions in the low-dose spinal group were not related to pain management or bladder management.…”

Factors affecting recovery and discharge following ambulatory surgery

“…13 In the fast-track group, 81% of patients bypassed the PACU successfully. Ninetyseven percent of patients undergoing arthroscopy met fast-track criteria and were able to bypass the PACU.…”