Length of stay and cost of care differences between postoperative patients who board in PACU and those that proceed directly to inpatient bed

Q2 Nursing

Perioperative Care and Operating Room Management Pub Date : 2024-09-20 DOI:10.1016/j.pcorm.2024.100434

David F Nelson , Carla Palomino , Marc C Torjman , Gavyn Ooi , Michael S Green

{"title":"Length of stay and cost of care differences between postoperative patients who board in PACU and those that proceed directly to inpatient bed","authors":"David F Nelson , Carla Palomino , Marc C Torjman , Gavyn Ooi , Michael S Green","doi":"10.1016/j.pcorm.2024.100434","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Bottlenecks in PACU throughput are frequently encountered challenges that OR managers must face. This study seeks to examine the impact of extended PACU stay (e.g. boarding) on both total hospital length of stay and overall cost of care.</div></div><div><h3>Methods</h3><div>A total of 4,740 patients were studied having same-day admit surgeries for seven procedure types including: arthroplasty total knee, arthroplasty total hip, fusion spine transforaminal interbody lumbar, revision arthroplasty total knee, revision arthroplasty total hip, posterior cervical fusion, and anterior cervical fusion. 4,471 were identified as non-PACU boarders and 269 as PACU boarders (>6 h in PACU). Included in the analysis were demographics, date of admission, surgical procedure, PACU and hospital length of stay (HLOS), hospital direct costs, case mix index (CMI), and ASA status.</div></div><div><h3>Results</h3><div>The median (IQR) PACU times in minutes were 57.00 (80) and 488.00 (453.50) minutes for PACU non-boarders and boarders (<em>p</em> < 0.001). HLOS was significantly (<em>p</em> < 0.001) more elevated in PACU Boarders compared to PACU Non-boarders: median (IQR) 2.00 (2.00) and 2.00 (3.00), (mean HLOS 3.16±2.83 vs 2.60±2.71 days). Median direct costs were ≈14.36% higher (<em>p</em> = 0.008) for the PACU boarders compared to Non-boarders. Direct costs were also not significantly different when using a 4-hour criteria for PACU boarders (14.39% higher median direct costs, <em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>PACU boarding (>4 h) is associated with a statistically significant increased length of stay as well as direct costs compared with non-boarders across a variety of elective orthopedic and spine procedures. Thus, when frequent PACU boarding occurs, OR managers should consider the potential impact to patient care and hospital margins.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100434"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perioperative Care and Operating Room Management","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405603024000670","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Nursing","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Bottlenecks in PACU throughput are frequently encountered challenges that OR managers must face. This study seeks to examine the impact of extended PACU stay (e.g. boarding) on both total hospital length of stay and overall cost of care.

Methods

A total of 4,740 patients were studied having same-day admit surgeries for seven procedure types including: arthroplasty total knee, arthroplasty total hip, fusion spine transforaminal interbody lumbar, revision arthroplasty total knee, revision arthroplasty total hip, posterior cervical fusion, and anterior cervical fusion. 4,471 were identified as non-PACU boarders and 269 as PACU boarders (>6 h in PACU). Included in the analysis were demographics, date of admission, surgical procedure, PACU and hospital length of stay (HLOS), hospital direct costs, case mix index (CMI), and ASA status.

Results

The median (IQR) PACU times in minutes were 57.00 (80) and 488.00 (453.50) minutes for PACU non-boarders and boarders (p < 0.001). HLOS was significantly (p < 0.001) more elevated in PACU Boarders compared to PACU Non-boarders: median (IQR) 2.00 (2.00) and 2.00 (3.00), (mean HLOS 3.16±2.83 vs 2.60±2.71 days). Median direct costs were ≈14.36% higher (p = 0.008) for the PACU boarders compared to Non-boarders. Direct costs were also not significantly different when using a 4-hour criteria for PACU boarders (14.39% higher median direct costs, p = 0.004).

Conclusions

PACU boarding (>4 h) is associated with a statistically significant increased length of stay as well as direct costs compared with non-boarders across a variety of elective orthopedic and spine procedures. Thus, when frequent PACU boarding occurs, OR managers should consider the potential impact to patient care and hospital margins.

查看原文本刊更多论文

在 PACU 住院的术后患者与直接转入住院病床的患者在住院时间和护理成本方面的差异

背景PACU吞吐量的瓶颈是手术室管理人员必须经常面对的挑战。本研究旨在探讨延长 PACU 住院时间（如寄宿）对总住院时间和总体护理成本的影响。研究方法共调查了 4740 名当天入院接受七种手术的患者，包括：全膝关节置换术、全髋关节置换术、经椎间孔腰椎融合术、全膝关节置换术翻修、全髋关节置换术翻修、颈椎后路融合术和颈椎前路融合术。4471人被确定为非PACU住院患者，269人被确定为PACU住院患者（在PACU住院6小时）。分析包括人口统计学、入院日期、手术过程、PACU 和住院时间（HLOS）、医院直接费用、病例混合指数（CMI）和 ASA 状态。结果 PACU 非住院患者和住院患者的 PACU 时间中位数（IQR）分别为 57.00 (80) 分钟和 488.00 (453.50) 分钟（p < 0.001）。与 PACU 非住院患者相比，PACU 住院患者的 HLOS 明显增加（p < 0.001）：中位数（IQR）分别为 2.00 (2.00) 和 2.00 (3.00)（平均 HLOS 为 3.16±2.83 天 vs 2.60±2.71 天）。与非住院患者相比，PACU 住院患者的直接费用中位数高出 14.36% (p = 0.008)。结论在各种选择性骨科和脊柱手术中，PACU寄宿（>4 h）与非寄宿者相比，住院时间和直接费用均有统计学意义上的显著增加。因此，当 PACU 频繁寄宿时，手术室管理人员应考虑到对患者护理和医院利润的潜在影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Perioperative Care and Operating Room Management Nursing-Medical and Surgical Nursing

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

56 days

期刊介绍： The objective of this new online journal is to serve as a multidisciplinary, peer-reviewed source of information related to the administrative, economic, operational, safety, and quality aspects of the ambulatory and in-patient operating room and interventional procedural processes. The journal will provide high-quality information and research findings on operational and system-based approaches to ensure safe, coordinated, and high-value periprocedural care. With the current focus on value in health care it is essential that there is a venue for researchers to publish articles on quality improvement process initiatives, process flow modeling, information management, efficient design, cost improvement, use of novel technologies, and management.