Is PACU necessary? Change may save $$$
Are you ready to re-think your post-anesthesia care unit (PACU) policies? Some 15% of patients who receive short-acting anesthetics may not need PACU care -- which means a potential cost savings of tens of thousands of dollars for facilities, according to researchers who are organizing a study of the new paradigm.
An outcomes research firm is looking for five same-day surgery sites to participate in a study that would determine the percentage of general anesthesia patients able to be transported directly from the OR to second-stage recovery and the resulting cost-savings.
In the short-activating, fast-emergence (SAFE) study, patients who had been given short-acting anesthetics such as propofol, mivacurium, and alfentanil would bypass the PACU if they met appropriate criteria, says Meredith Farrance, logistical data manager at Pharmaceutical Outcomes Research, a Buffalo-based firm specializing in pre-drug approval and outcomes studies.
"It's an evaluation for a new paradigm for postoperative recovery room utilization," says Farrance.
Patients must pass PACU criteria
The recovery discharge assessment traditionally performed in the PACU would be performed in the OR just prior to recovery room transport, she says. Criteria for the PACU bypass include requirements for the patient to be awake, alert, oriented, and responsive. The patient must also have minimal pain, no active bleeding, stable vital signs, minimal nausea, no vomiting, and oxygen saturation of >94% or return to baseline.
The first SAFE site is expected to begin in May, and the study will be accepting inquiries from potential participants through July.
The study will last four to six months, including one month of baseline data collection, about one month of intervention implementation, one month of follow-up data collection, and an analysis period. The study will track clinical information, such as the anesthetic used, procedure type, and any complications or adverse events, as well as financial information.
The study will accept both hospital-based ambulatory surgery sites as well as surgery centers, but participants must perform at least 60% of their surgeries on an outpatient basis and must be able to differentiate PACU and second-stage recovery costs, Farrance says.
SAFE organizers also are looking for sites with a "champion who is committed to the project," she says. If the facility mandates a minimum stay in the PACU, that policy must be changed to accommodate the study, she says.
The study's principal investigator is Jeffrey Apfelbaum, MD, vice chair of clinical affairs in the department of anesthesia and critical care at the University of Chicago Hospital and Clinics in Chicago. The advisory board for the study is composed of facility administrators, anesthesiologists, CRNAs, epidemiologists, medical educators, and an econometrician.
[Editor's note: For more information about the SAFE study, contact Meredith Farrance, Logistical Data Manager, Pharmaceutical Outcomes Research, 435 Lawrence Bell Drive, Suite 7, Williamsville, NY 14221. Telephone: (716) 633-3463. Fax: (716) 633-7404.] *
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