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BJA Advance Access published online on September 17, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh265
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted July 12, 2004

Clinical Investigation

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

D. Song 1, F. Chung 1*, M. Ronayne 1, B. Ward 1, S. Yogendran 1, and C. Sibbick 1

1 Department of Anesthesia, Toronto Western Hospital and Nursing Information Systems, Toronto General Hospital, University Health Network, University of Toronto, Canada

* To whom correspondence should be addressed. E-mail: frances.chung{at}uhn.on.ca.


  Abstract

Background. Postoperative day-case patients are usually allowed to recover from anaesthesia in a postanaesthesia care unit (PACU) before transfer back to the day surgical unit (DSU). Bypassing the PACU can decrease recovery time after day surgery. Cost savings may result from a reduced nursing workload associated with the decreased recovery time. This study was designed to evaluate the effects of bypassing the PACU on patient recovery time and nursing workload and costs.

Methods. Two hundred and seven consenting outpatients undergoing day surgery procedures were enrolled. Anaesthesia was induced and maintained with a standardized technique and the electroencephalographic bispectral index was monitored and maintained at 40-60 during anaesthetic maintenance. At the end of surgery, patients were randomly assigned to either a routine or fast-tracking (FT) group. Patients in the FT group were transferred from the operating room to the DSU (i.e. bypassing the PACU) if they achieved the FT criteria. All other patients were transferred to the PACU and then to the DSU. Nursing workload was evaluated using a patient care hour chart based on the type and frequency of nursing interventions in the PACU and DSU. A cost associated with the nursing workload was calculated.

Results. The overall time from end of anaesthesia to discharge home was significantly decreased in the fast-tracking group. However, overall patient care hours and costs were similar in the two recovery groups.

Conclusion. 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.

Keywords: anaesthesia, ambulatory; recovery, fast tracking; surgery, day-case.
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