Peri-Anesthesia Care Unit
Description of the Unit
The Peri- Anesthesia Care Unit in the North & South Tower is located on the second floor, adjacent to the Operating Rooms. The PACU is organized into three different areas: Pre-op holding, Main Recovery (Phase I) and Ambulatory Surgery (Phase II). Care is provided 24 hours a day, 7 days a week.
North Tower Pre-Operative Holding
Pre-op holding has ten bed spaces; four of the bed spaces are capable of complex hemodynamic monitoring (ECG, IBP, NIBP and oxygen saturations). Only oxygen saturation and NIBP is only available at the remaining bed spaces. Patients are admitted preoperatively from either the Ambulatory Surgical Waiting Room or from the surgical floors. Approximately 900 plus patients per month are seen in Pre op Holding. Hours of operations are 0600-1830, Monday through Friday. Pre-op patients are accommodated in PACU off hours.
South Tower Pre-Operative Holding
Pre-op holding has ten bed spaces, one interventional room, and six block spaces. All beds are capable of complex hemodynamic monitoring. Patients are admitted preoperatively from surgical floors. Approximately 400 plus patients per month are seen in pre-op holding. Hours of operation are 0600 – 1830, Monday through Friday. Pre-op patients are accommodated in PACU off hours.
North Tower Main Recovery (Phase I)
Main Recovery consists of 19 bed spaces with the capability of converting slots 17 or 18 and 19 into negative pressure isolation rooms. These slots are used as main recovery slots if isolation is not needed. Each slot in PACU has the capability of ECG, NIBP, capnography, CVP, and arterial monitoring. PACU slots are able to handle mechanically ventilated patients. All bed spaces are equipped with a direct emergency alarm system to the operating room and the anesthesia attending office. A center wall divides the pediatric and adult population from each other. Phase I recovery focuses on providing a safe transition from the immediate post anesthesia period and transitioning the patient to Phase II, in the inpatient setting or to an intensive care setting for continued care. Approximately 900-1200 patients per month are seen in the Main Recovery. Hours of operation are 24 hours a day seven days a week.
South Tower Main Recovery (Phase 1)
Main recovery consists of 14 bed spaces plus 2 isolation rooms. Each slot in PACU has the capability of ECG, NIBP, capnography, CNP, and arterial monitoring. PACU slots are able to handle mechanically ventilated patients. All bed spaces are equipped with a direct emergency alarm system to the operating room. Phase I recovery focuses on providing a safe transition from immediate post anesthesia period & transition the patient to Phase II, the inpatient setting, or to an intensive care setting for continued care. Approximately 400 – 600 patients are seen in main recovery. Hours of operation are 24 hours a day seven days per week.
North Tower Ambulatory Surgery (Phase II)
The Ambulatory Surgery Unit consists of six bed spaces. NIBP and oxygen saturation monitoring are available at each bedside. Generally postoperative outpatients are admitted to the Phase II area after an initial postoperative period in Phase I. Inpatients can be admitted to the Phase II area if they meet the appropriate admission criteria their recovery can be completed in Phase II prior to their transfer back to the floor. Fast tracking involves admitting patients from the operating room directly to Phase II and bypassing Phase I. This practice occurs based on established admission criteria. Patient care in Phase II is directed at preparations for discharge home or an extended care facility. Hours of operations are 0800-2030, Monday through Friday. Approximately 350-400 patients per month are seen in the Phase II area. Ambulatory surgery patients are cared for in the main recovery after hours and on Saturday and Sunday.
South Tower Ambulatory Surgery (Phase II)
The Ambulatory Surgery Unit consists of eight bed spaces all spaces are capable of complex hemodynamic monitoring ECG, NIBP, capnography, CVP, and arterial monitoring. Generally postoperative outpatients are admitted to Phase II after an initial post-operative period in Phase I. Inpatients can be admitted to the Phase II area if the meet the appropriate admission criteria. Their recovery can be completed in Phase II prior to their transfer back to the floor. Fast tracking involves admitting patients from the operating room directly to Phase II bypassing Phase I. This practice occurs based on established admission criteria.
The ambulatory surgery unit bed spaces often serve a dual role at the beginning of the OR schedule. Outpatients are often admitted to those bed spaces which serve in a pre-operative holding capacity. After the initial cases are started, they revert back to a Phase II role.
The PACU is a patient care area which provides acute care to adults and pediatric patients who undergo anesthesia-related procedures including general and regional anesthesia. This includes the immediate preoperative and postoperative phases of surgical care and nonsurgical post anesthesia care.
The exceptions to this are those patients who require the technology available in the intensive care units. The Recovery Room can accommodate a limited number of patients staying overnight as Floor/IMC/SICU. The most common surgical procedures include exploratory laparoscopies, total hip arthroplasties, hysterectomies, cystoscopies, various types of vascular surgeries such as triple A’s, angioplasties and angiograms. Various Neurosurgery procedures are recovered in the PACU also i.e., craniotomies, cervical fusions, neck dissections, endartarectomies, and stenting procedures. The optimal length of stay for the postanesthesia unit is 90 minutes.
The Nursing staff in the PACU strives to achieve excellence in quality patient care through the utilization of the nursing process. The job description identifies specific patient populations served, the equipment utilized, the skills performed, the clinical parameters monitored, the safety precautions, and the emergency events encountered. The PACU nursing staff is committed to patient advocacy and innovative patient care through the assessment, diagnosis, evaluation and treatment of: pain and nausea, respiratory compromise, fluid and electrolyte abnormalities, neurological changes, and hemodynamic instability. They assess the patient’s needs preoperatively both physically and psychologically. The patient’s Peri-operative process is coordinated through the use of the Preoperative Clinical Pathway. The PACU nurse works hard to minimize family anxiety by providing updates and visitation while the patient is in PACU. The outpatient discharge needs are assessed by the ambulatory nurse to make sure the patient receives optimal care at home after discharge. Feedback is solicited regarding patient satisfaction through third party solicitation. Patients are called randomly after discharge from the hospital and they are asked to evaluate their experience while they are at our facility. Changes are made to our processes if possible based on the feedback received.
The Medical Director of the PACU is an attending anesthesiologist appointed by the Department of Anesthesiology. Huong (Cindy) Le, MD is the current medical director of the PACU. The medical director assists with policy and procedure development, and assists the educator with continuing education activities. Medical staff coverage is coordinated by the Department of Anesthesiology. An anesthesia resident is assigned to the PACU for a period of one month. He assists with all pain management issues, hemodynamic issues and signs the patients out from the Phase I and II areas if all discharge criteria have been met. Off shift coverage is provided by the anesthesia resident and or attending on call.
The nursing management structure of the PACU consists of a Nurse Manager, and a Clinical Leader. The staff nurse educator is responsible for coordinating the education of new staff, in services and all training updates. The unit practice council fosters autonomous, accountable nursing practice by supporting staff involvement in unit practice decision making. Collaboration on the unit among nurses is fostered by precepting, mentoring, and encouraging the team approach to holistic care.
Patient assignments are made by the charge nurse based on the identification of patient care needs and competency levels of the practitioner. Social Workers, Respiratory and Physical Therapists and Pharmacists support the PACU staff in meeting the additional needs of the patient, family and staff.