beds and 15 recovery beds in the ambulatory care unit. The facility
performs more than 4,000 ambulatory procedures per year and admits
all patients to Phase I PACU following emergence from anesthesia —
regardless of age, anesthetic or any other factor. Cervical fusion or
cataract removal, it didn't matter. Their post-op recovery policy said
to park all patients in Phase I PACU.
So the question became: Could we bypass Phase I PACU and send
eligible patients straight to Phase 2 recovery? But before we could cre-
ate a passing lane on the recovery highway, we had to teach Duke's
anesthesia providers how to fast-track. We trained them to use the
White Fast-Track Score to assess which patients were eligible to
bypass Phase I PACU and go directly from the OR to Phase 2. We only
considered patients undergoing ambulatory surgery who received IV
sedation, peripheral nerve blocks or a combination of the two.
As we detailed in our study in the Journal of PeriAnesthesia
Nursing (osmag.net/GP7geR), the results were dramatic. The hospi-
tal:
• achieved a 79% PACU-bypass rate;
• lowered post-op-to-discharge time from 106 minutes to 94 min-
utes; and
• significantly decreased the incidence and duration of OR hold.
Though we studied outpatients in a community hospital, our study
produced lessons that apply to any outpatient OR, regardless of set-
ting.
1. Segregate fast-track patients.
We implemented 2 post-operative phases of care: Phase 1 (require
more nursing interventions; expected to be admitted) and Phase 2
(fast-track-eligible; ambulatory patients). We reserved a set of bays for
Phase 2 patients and assigned them a team of PACU nurses (1:3
J U L Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 5 5
