PACU Holds?

[Stimulate]

My institution is becoming plagued by PACU holds, i.e. there aren't enough hospital beds to accept the patients in the recovery room so the operating room flow gets backed up. Last week I spent probably 3-4 hours just sitting in the OR charting vitals every 15 minutes waiting for a PACU bed.

Does anyone else have this problem at their institution, and if so, how have the residents and staff dealt with it? Many residents are upset because there is no academic value to functioning as a recovery nurse.

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[supahfresh]

Where are you? I'm at Yale and our hospital has been jammed packed lately. I feel your pain.

 

[Noyac]

This would never happen in a private hospital as long as they are interested in making money, which they all are. Every minute not occupied by an actual surgery is wasted money.

Now, I did have this happen to me once in residency. I grabbed a transport monitor and took my pt from the OR after the PACU told that the were full and waited in the doorway until the next stall opened up. I made sure I was next. I never was told the PCAU was full again.

 

[supahfresh]

Noyac, this would just piss people off at my institution. i'm not sure if it's worth it to me.

 

[Bougie]

our institution pays $50/hour when residents have to babysit patients in the OR when the PACU is full. It still sucks to be a PACU nurse but at least there is some compensation.

 

[jwk]

I assume y'all continue charging for your anesthetic as long as you're with the patient. Anesthesia time plus OR time = very expensive PACU.

If your RN's in the OR are ACLS-certified and cross-trained for PACU work (not unusual), sign out to the RN in the OR just like you would if you dropped them off in PACU.

And Noy - it does happen in private practice. We occasionally have patients spend the night in the PACU because there are no beds available in the house.

 

[supahfresh]

our institution pays $50/hour when residents have to babysit patients in the OR when the PACU is full. It still sucks to be a PACU nurse but at least there is some compensation.

Really? man, we're getting screwed.

 

[Noyac]

Yes, they do spend some extra time in the PACU in PP but not in the OR. If your facility is allowing them to remain in the OR it is a terrible trend for that facility and not to mention very expensive.

Superfresh, if you are out of the room the cleaning crew can do there job and the staff can begin setting up for the next case. With your pt in the room these things can't occur. So you piss some people off. Tell them if they were doing their jobs then this wouldn't happen. I'm speaking mostly of administration here. Its their job to make sure the ship runs smoothly.

 

[thegasman]

Our hospital just cancels cases if there is nowhere to put them.

 

[Chillio]

We also get stretches of PACU hold every now and then. That 50 bucks an hour sounds really nice, I guess we're getting screwed too!

 

[iron]

A couple of ways around recovering in the OR that may fit your situation:

Often "no beds" means not enough nurses in PACU to cover the patients. So I offer to sit in the PACU (or offer a resident/CRNA/AA) and recover my patient there instead of the OR. This opens the OR to cleaning and when a nurse is available in the PACU the next patient, mine, is already there. Also I (or a resident or CRNA) can take a second patient to recover so another OR is available as is another anesthesia provider.

Patients recovered in the OR can be transported to the floor directly. I realize that the back-up may begin at the floor so this option isn't viable.

A third option that has to come from above is no surgeries if there are no discharges. Pushing the surgeons to do their discharges early in the day so beds are available for in-coming patients.