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At least 19 recordsLinked to original sources
PubMed2006

Maximizing operating room and recovery room capacity in an era of constrained resources.

HYPOTHESIS: Three parallel processing operating rooms (ORs) (concurrent induction and turnover) with a dedicated 3-bed mini-recovery room (mini-postanesthesia care unit [PACU]) will optimize patient throughput and main PACU workload when compared with 4 traditional ORs or 4 parallel processing ORs. DESIGN: Statistical and mathematical models projected the impact of parallel processing on case throughput and PACU use. SETTING: Academic medical center with 48 traditional ORs using serial induction and turnover and 1 experimental OR, the operating room of the future, with parallel processing. PARTICIPANTS: All surgical cases from October 2002 through March 2004 (N = 49 887). INTERVENTIONS: A statistical model projected the duration of induction, surgery, turnover, and PACU stay for cases performed in a traditional OR (n = 48 667) based on the operating room of the future (n = 1220) experience. A fluid queuing model compared each combination using specific probability density functions. MAIN OUTCOME MEASURES: Each OR configuration was evaluated for case throughput and minutes of work sent to the PACU. RESULTS: Although all cases save OR time with parallel processing, only select surgeon-case combinations translate time saved into additional cases per day (26%). Without additional PACU slots, output from 4 parallel processing ORs further stresses the PACU. Three parallel processing ORs and a mini-PACU balances incremental volume by offsetting PACU utilization in 84% of cases. CONCLUSION: In a PACU-constrained environment, 3 parallel processing ORs with a mini-PACU configuration offers increased throughput and decreased PACU workload.

Academic Medical Centers↗
PubMed2006

The effect of direct-from-recovery room discharge of laparoscopic cholecystectomy patients on recovery room workload.

Ambulatory laparoscopic cholecystectomy pathways move patients through the hospital without encountering delays caused by congested inpatient bed units. However, redirecting patients to a direct discharge pathway might not be beneficial if recovery capacity is further taxed by additional workload. In this study, we attempt to assess the operational impact on recovery room workload of directly discharging laparoscopic cholecystectomy patients to home. We conducted a retrospective case-control review of recovery room flow sheets to determine recovery room time and effort required for laparoscopic cholecystectomy patients. The study was restricted to patients of a single surgeon to minimize confounds from surgical technique. Fifty-seven case patients (May 1, 2004, through November 30, 2004), all managed with intent to directly discharge from the recovery room, were compared with control patients (n = 81) from the corresponding 6 months in the year before the direct-discharge plan. The times (mean; 95% confidence interval) to meet objective criteria for adequate pain control (3.5 minutes [2.1 to 5.9] versus 4.0 minutes [2.6 to 6.1]) and readiness for discharge from phase 1 recovery (8.1 minutes [4.8 to 13.6] versus 6.1 minutes [4.0 to 9.5]) were not different between the groups. The number and distribution of interventions documented in the recovery process were not different between groups, nor was there a difference in recovery room length of stay (158 minutes [138 to 182] versus 149 minutes [132 to 167]). In our study, recovery room records reveal little if any increased workload associated with the direct-to-home discharge of laparoscopic cholecystectomy patients.

Cholecystectomy, Laparoscopic↗
PubMed1995

Toward 2001. The recovery room revisited.

Recovery room nursing is more accurately described by the term "post-anaesthesia nursing." Issue of patient safety, standards of care and staff training in the recovery room have been highlighted by the Association of Anaesthetists in two reports. Current training and education provision for post-anaesthesia nurses is provided by combined operating department nursing and anaesthetic nursing curricula (ENBI182:83). There are few courses designed for nurses who specialize in the care of the post-anaesthesia patient.

Clinical Competence↗
PubMed1997

[The perioperative phase as a part of anesthesia. Tasks of the recovery room].

Historically, recovery rooms were established in order to reduce complications in the period immediately following surgery and anaesthesia, utilising staffing and equipment resources economically. To minimise the incidence of postoperative complications remains the main task of post anaesthesia care units (PACU). However, especially in hospitals with a high degree of surgical emergencies, the scope of tasks and procedures within the PACU has expanded. Facing restricted capacities in intensive therapy (ITU) and high dependency units (HDU) the PACU serves as a buffer; intensive care functions can be covered here until the patient can be admitted to an intensive care unit. In this context, the PACU also has a switch function; postoperatively, the patient is evaluated here and the level for further treatment determined: ITU, HDU, or normal ward. The PACU period can be utilised to improve the patient's condition (upgrade function) enabling continuation of treatment on a lower level (HDU instead of ITU, normal ward instead of HDU). This combination of buffer, switch and upgrade function is of special importance when ITU and HDU resources are limited. A new task for the PACU arises from efforts to optimise acute pain therapy; initial adjustment of continuous infusion systems according to the patients' needs can be performed here without additional staffing requirements. Finally, the PACU can be used preoperatively for "tune up" procedures in high risk patients. The basis for co-operation between anaesthetist and surgeon is the separation of responsibilities in combination with mutual trust. Accordingly, the anaesthetist is responsible for monitoring and maintenance of vital functions. Consequently, the anesthetist has a professional and organisational responsibility in the PACU. The surgeon can and must rely on notification whenever surgical complications may require his intervention. With increasing comorbidity of patients and complexity of surgical procedures the anaesthetist's responsibility in the immediate perioperative period gains a new quality. The number of surgical procedures requiring intraoperative intensive therapy from the anaesthetist is increasing; the delivery of anaesthesia becomes a background task during these operations. Thus, the anaesthetist becomes responsible for perioperative patient treatment in the operating room area which divides into three phases: preoperative "tune up" in the PACU (e.g.) haemodynamic optimisation, starting continuous regional anaesthesia techniques), anaesthesia and support of vital functions in the OR, and immediately postoperative treatment in the PACU.

Anesthesia↗
PubMed1985

Comprehensive pharmaceutical services in the surgical suite and recovery room.

The operation of a pharmacy satellite located within the operating suite of a large university hospital is described. The satellite provides comprehensive services 24 hours a day, seven days a week to the staff of the operating room (OR), recovery room, and anesthesia department. Kits of anesthetic agents and other drugs used by the anesthetist and surgeon are prepared for each surgical procedure. The pharmacy staff also prepares i.v. admixtures, cardioplegic solutions, and specialized preparations as needed for surgery and provides drugs and i.v. admixture services to the recovery room for postoperative patients. Controlled substances are signed out to the anesthetist as needed in the particular kits and are issued as single doses upon request to the recovery room. All pharmacy charges to patients in the OR are done directly from the pharmacy satellite using a computer charging system. The decentralized pharmacy satellite has substantially reduced drug loss and waste, improved drug delivery to patients, increased revenue for the institution, reduced drug inventory, improved controlled-drug distribution and accountability, improved clinical services, and eased the nursing workload by reassigning drug-related responsibilities to the pharmacy department. The OR pharmacy satellite is a viable cost-effective operation.

Centralized Hospital Services↗
PubMed1987

[Pulse oximeter. Clinical assessment in the recovery room].

Fifty unselected recovery room patients were monitored using a Nellcor N101 pulse oximeter. Non invasive SaO2 values were compared with simultaneous spectrophotometric measurements made on arterial blood samples (Co-oximeter). Mean pulse oximeter SaO2 was 86.9 +/- 6.08%, with extreme values of 68 and 95.5%. Arterial blood SaO2 was 91.25 +/- 6.28%, with extreme values of 66 and 100%. Linear regression analysis showed a good correlation between the two sets of measures (r = 0.97; p less than 0.005). Twenty one patients had a SaO2 below 90% (mean: 84.83 +/- 5.93%); their measured arterial SaO2 was of 86.14 +/- 6.32%. The correlation between the two sets of low values was good (r = 0.96; p less than 0.05). Pulse oximetry was a non invasive reliable method, but there were some limits to its clinical use. Hypothermia or shock vasoconstriction precluded the measurement of SaO2. Restlessness or shivering were responsible of probe dysfunction and false alarms. False SaO2 readings may result from high levels of carboxyhaemoglobin or dye infusion. Also, each disposable finger probe was reused for a mean of five patients, its cost being relatively high (170 FF, i.e. 28.3 US dollars).

Adult↗
PubMedDate not supplied

[Determination of subanesthetic concentrations of halothane in the environment of operating and recovery rooms].

Concentrations of halothane in parts per million (ppm) in the air were determined during 4 days in the operating rooms and the recovery room of pediatric surgery during the course of surgical anesthesia by inhalation. The operating rooms did not have an anesthetic gas scavenging system. Eighteen samples of air were taken by passive diffusion in sampling tubes of activated charcoal (mode Dräger Orsa 5). The samples were analysed by gas chromatography). We found concentrations between 4.7 ppm and 34.2 ppm that exceed those considered as admissible that range from 2 to 5 ppm. Our present recommendations to reduce the atmospheric contaminating anesthetic gases are the use of scavenging equipment, air-conditioned rooms and routine inspection and leak detection of apparatus and anesthetic circuits.

Air Pollutants, Occupational↗
PubMed1991

A review of 6978 consecutive admissions to the recovery room at a university hospital.

Recovery from anaesthesia is a time of potential danger to the surgical patients. A retrospective audit of all recovery room admissions over a period of 18 months was carried out at the Aga Khan University Hospital. During this period 6978 patients were admitted to the recovery area and 695 had one or more complications. The complications were recorded by the recovery room nursing staff in a recovery log book. The breakdown of complications according to different physiological systems is discussed. Several surveys have reviewed complications in the western population, but in contrast, no study is available in Pakistani patients. It is recommended that since one in ten patients is likely to have a problem in the early post-operative period, the local hospitals should provide adequate facilities meeting the criteria laid down for the recovery rooms in modern anaesthetic practice.

Adult↗
PubMed1988

The effect of transportation between the recovery room and intensive care unit on postoperative acoustic tumor patients.

Cardiovascular changes have been noted to occur during movement from the operating room or recovery room (RR) to the intensive care unit (ICU). This study examined blood pressure changes and related variables during transport from the RR to the ICU in 135 postoperative acoustic tumor patients. Although there was no significant change in blood pressure values from the RR to the ICU, patients with pre-existing hypertension and elevated RR blood pressures were noted to have an increased frequency of postoperative complications. In addition, a relationship was noted between administration of halothane and frequency of postoperative complications. Results highlight the need for nurses not only to monitor, but also closely control postoperative blood pressure in this population.

Blood Pressure↗
PubMed1980

Operating room temperature prior to surgical draping: effect on patient temperature in recovery room.

Assessment was made of whether a cold-room environment prior to surgical draping affected patient temperature or the incidence of shivering in the recovery room in patients undergoing major vascular surgery when warming blankets and warmed fluids were used to maintain intraoperative temperature. Forty-two patients scheduled to undergo major vascular surgery were randomly assigned in equal numbers to a "cold or "warm" room. Temperatures in the "warm" rooms were 22.2 C or above (range 22.8-25.6 C) until draping, and in "cold" rooms, 18.9 C or below (ranged 13.9-17.8 C). Once surgical drapes were placed, the room temperature control was set at its minimum, 17 C. All intravenous fluids and blood were warmed to 37.5 C, and a heating blanket was maintained at 37.8 C before and during the operative procedure. Patient temperatures initially did not differ between groups. Despite significantly greater heat loss prior to draping in the cold-room group (0.63 +/- 0.14 C) than in the warm-room group (0.32 +/- 0.10 C) (p < 0.01), there were no differences in temperature in the recovery room, shivering, myocardial, renal CNS, pulmonary, or graft morbidity in the two groups. In major intra-abdominal vascular operations the use of warming blankets and the practice of warming all fluids for infusion allow a comfortable room temperature without detriment to patient care.

Body Temperature↗
PubMed1990

Simulation of nitrous oxide concentrations in operating and recovery rooms.

A model was developed to predict nitrous oxide (N2O) concentrations in operating (OR) and recovery rooms. The model incorporates general ventilation characteristics, percentage recirculation and the rate at which N2O is emitted into the OR (emission) for the calculation of environmental exposure. A workplace study was carried out during which N2O concentrations were measured continuously and coupled to anaesthetic activities (type and duration), air-change rate and percentage of recirculated air. The data from this study were used to calculate N2O emission. Subsequently, the model was used to predict the effect of technical measures to reduce emissions on mean environmental exposure. After implementation of the control measures an intervention study was made to check whether the reduction in exposure was predicted by our simulation model. Subsequently the 'validated' simulation model was used: (i) to calculate the exposure for different percentages of recirculation and different air-change rates, and (ii) to estimate N2O levels in another situation, i.e. an operating room in an outpatients clinic. In short, our study shows how modelling can help both occupational hygiene and hospital management to control exposure to anaesthetic gases and to design or adapt ventilation systems of operating rooms and recovery rooms.

Computer Simulation↗
PubMed2001

Postoperative nausea and vomiting in the recovery room. A report from Guyana.

Postoperative nausea and vomiting (PONV) in patients in the recovery room can delay transfer of such patients to the wards, preventing a smooth inflow of patients into the recovery area. The high incidence of these complications in developed countries has led to the introduction of management strategies that may be too expensive for developing countries. An investigation of the incidence and factors associated with PONV in the recovery room of the Public Hospital, Georgetown, Guyana, was undertaken with a view to developing an approach to its management based on local data. Seven hundred and sixty patients were studied. The majority (97%) had general anaesthesia. Simple anaesthetic techniques involving agents of relatively low cost were used. Anti-emetics were infrequently administered. Only twenty-two patients (2.9%) experienced PONV in the recovery room, all after general anaesthesia. Twenty-one of these (95%) had risk factors for PONV in their history. PONV in the recovery room was associated with female gender, gynaecological surgery, extra-abdominal surgery and lack of anti-emetic medication (p < 0.05), as well as prolonged duration of recovery room stay (p < 0.01). A management strategy for PONV in the recovery room involving continued use of present anaesthetic agents, increased use of inexpensive anti-emetic drugs currently available in Guyana, and targeting of patients found to be more at risk is suggested. Increased regional techniques may also be appropriate.

Adolescent↗
PubMed1987

Arterial desaturation in healthy children during transfer to the recovery room.

The oxygen saturation in 71 healthy paediatric patients (3.5 months to 16.7 years) was measured by pulse oximetry during transfer from the operating room to the recovery room. These measurements were recorded continuously while the patients breathed room air. Of the patients studied, 28.1 per cent exhibited significant arterial desaturation of less than or equal to 90 per cent. The corresponding PO2 for this saturation level is less than or equal to 58 mmHg. In only 45 per cent of these desaturated patients was the desaturation recognized clinically by the presence of cyanosis. Age, type of anaesthetic, the use or avoidance of narcotics, and the use of controlled or spontaneous respiration had no significant relationship to the incidence of desaturation. Since more than a one quarter of all patients studied desaturated significantly, and since cyanosis can be difficult to detect clinically during the transfer period, the use of supplemental oxygen during transfer should be considered by the anaesthetist at the end of every paediatric general anaesthetic.

Adolescent↗
PubMed2005

Recovery room delirium predicts postoperative delirium after hip-fracture repair.

UNLABELLED: In this study, we sought to determine the incidence of recovery room delirium in elderly patients having hip-fracture repair under general anesthesia and to discover whether recovery room delirium is associated with continuing postoperative delirium. In this prospective study, patients undergoing hip-fracture repair were anesthetized using a standardized protocol. In addition, postoperative pain management was standardized in both the postoperative anesthesia care unit and in the hospital ward. The presence of delirium was determined using the confusion assessment method (CAM) score. Recovery room delirium was assessed by obtaining a CAM score at 60 min after discontinuation of isoflurane. Postoperative delirium was assessed by obtaining a daily CAM score during the postoperative in-hospital recovery period. Fifty patients consented to the study and 47 patients were included in the analysis (surgery cancelled postinduction n = 1; nonadherence to protocol n = 2). Average patient age was 77 +/- 1 (mean +/- SE) yr (range, 56-98 yr). Seventy-seven percent of the study patients were ASA class III or more. The prevalence of recovery room delirium was 45%. The prevalence of postoperative delirium was 36%. Recovery room delirium predicted postoperative delirium (P < 0.001, Fisher's exact test) with a sensitivity of 100% and a specificity of 85%. Analgesic doses administered in the postoperative anesthesia care unit and ward were similar in patients with or without postoperative delirium. Results of this study show that recovery room delirium is a strong predictor of postoperative delirium. IMPLICATIONS: In patients undergoing hip-fracture repair, recovery room delirium is a strong predictor of postoperative delirium when using a standardized protocol for general anesthesia and postoperative pain management.

Aged↗