Holding some postoperative patients overnight in the post-anesthesia care unit as a tactic to deal with hospital congestion is associated with increased resource length of stay

Nelson, Sara E.; Sandberg, Warren S.; Clifton, Jacob C.; Cui, Yu; Shotwell, Matthew S.; Wanderer, Jonathan P.

doi:10.1016/j.pcorm.2020.100111

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…Such flexibility might require hospitals to change their policies regarding the overnight boarding of patients in the PACU. Still, as Nelson et al demonstrated, there was a reduction in the length of stay when patients with an expected length of stay ≤1 day were kept in the PACU overnight [13]. We think the likely reason for this finding was that there was a motivation to discharge patients early the next morning from the PACU to make room for the next day's surgical schedule.…”

Section: Discussionmentioning

confidence: 98%

“…The effect on the census would be immaterial if the patients were kept in the PACU overnight and then discharged home the next day. Nelson et al demonstrated that patients with an expected length of stay ≤1 day who were held in the PACU overnight had a smaller difference between their expected and actual lengths of stay compared to patients not staying in the PACU overnight (−0.096 days, 95% CI −0.30 to −0.031 days) [13].…”

Section: Introductionmentioning

confidence: 99%

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Policy Implications for the COVID-19 Pandemic in Light of Most Patients (≥72%) Spending Only One Night at the Hospital After Elective, Major Therapeutic Procedures

Epstein¹,

Dexter²,

Smaka³

et al. 2020

Cureus

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Policy Implications for the COVID-19 Pandemic in Light of Most Patients (≥72%) Spending Only One Night at the Hospital After Elective, Major Therapeutic Procedures

Epstein¹,

Dexter²,

Smaka³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…Most hospitals did not even have 50% of discharges before 3 PM [16]. However, Nelson et al examined 778 patients with overnight stays in the post-anesthesia care unit [17]. The patients with LOS ≤ 1 day were discharged approximately 24% faster than equivalent patients staying on a hospital ward [17].…”

Section: Discussionmentioning

confidence: 99%

“…However, Nelson et al examined 778 patients with overnight stays in the post-anesthesia care unit [17]. The patients with LOS ≤ 1 day were discharged approximately 24% faster than equivalent patients staying on a hospital ward [17]. Assel et al examined the postoperative length of stay of patients being discharged the day after surgery [18].…”

Section: Discussionmentioning

confidence: 99%

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Proportions of Surgical Patients Discharged Home the Same or the Next Day Are Sufficient Data to Assess Cases’ Contributions to Hospital Occupancy

Dexter¹,

Epstein²,

Shi³

2021

Cureus

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Introduction When the hospital census is high, perioperative medical directors or operating room (OR) managers may need to consider postponing some surgical cases scheduled to be performed within the next three workdays. This scenario has arisen at hospitals in regions with large increases in admissions due to coronavirus disease 2019 (COVID-19). We compare summary measures for hospital length of stay (LOS) to guide the OR manager having to decide which cases may need to be postponed to ensure a sufficient reserve of available inpatient beds. Methods We studied the 1,201,815 ambulatory and 649,962 inpatient elective cases with a major therapeutic procedure performed during 2018 at all 412 non-federal hospitals in Florida. The data were sorted by the hospital, and then by procedure category. Statistical comparisons of LOS were made pairwise among all procedure categories with at least 100 cases at (the) each hospital, using the chi-square test (LOS ≤ 1 day versus LOS > 1 day), Student's t-test with unequal variances, and the Wilcoxon-Mann-Whitney test. The comparisons among the three tests then were repeated having sorted the data by procedure category and making statistical comparisons among all hospitals with at least 100 cases for the procedure category. Results Whether using a criterion for statistical significance of P < 0.05 or P < 0.01, and whether compared with Student's t-test with unequal variances or Wilcoxon-Mann-Whitney test, the chi-square test had greater odds (i.e., greater statistical power) to detect differences in LOS (all four with P < 0.0001 and all 95% lower confidence limits for odds ratios ≥ 3.00). The findings were consistent when the data, first sorted by procedure category and then by probability distributions of LOS, were compared between hospitals (all P < 0.0001 and the 95% lower confidence limits for odds ratio ≥ 3.72). Conclusions For purposes of comparing procedure categories pairwise at the same hospital, there was no loss of information by summarizing the probability distributions using single numbers, the percentages of cases among patients staying longer than overnight. This finding substantially simplifies the mathematics for constructing dashboards or summaries of OR information system data to help the perioperative OR manager or medical director decide which cases may need to be postponed, when the hospital census is high, to provide a sufficient reserve of inpatient hospital beds.

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Length of Stay and Cost of Care Differences Between Postoperative Patients Who Board in PACU and Those That Proceed Directly to Inpatient Bed

Nelson,

Palomino,

Torjman

et al. 2024

Perioperative Care and Operating Room Management

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Holding some postoperative patients overnight in the post-anesthesia care unit as a tactic to deal with hospital congestion is associated with increased resource length of stay

Cited by 4 publications

References 6 publications

Policy Implications for the COVID-19 Pandemic in Light of Most Patients (≥72%) Spending Only One Night at the Hospital After Elective, Major Therapeutic Procedures

Policy Implications for the COVID-19 Pandemic in Light of Most Patients (≥72%) Spending Only One Night at the Hospital After Elective, Major Therapeutic Procedures

Proportions of Surgical Patients Discharged Home the Same or the Next Day Are Sufficient Data to Assess Cases’ Contributions to Hospital Occupancy

Length of Stay and Cost of Care Differences Between Postoperative Patients Who Board in PACU and Those That Proceed Directly to Inpatient Bed

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