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2016 Best Nursing Team Runner-Up Duke University Medical Center The PACU team implemented phased postoperative care in the OR platform IN SEPTEMBER 2014, the Duke University Hospital PeriAnesthesia Care Unit (PACU) Team partnered with anesthesia colleagues to implement phased postoperative care in our operating room platform. Our 120+ member team overcame challenges to achieve a significant reduction in the average recovery care time for patients in the Duke University Hospital PACU, while improving their overall experience. Prior to September 2014, the Duke University Hospital PACU was a single-phase, mixed care area that safely treated more than 25,000 patients each year. Our average length of stay for ambulatory patients exceeded national benchmarks at 120 minutes. National data show that top-performing facilities safely recover and discharge ambulatory surgery patients in less than 60 minutes. We identified phased PACU care as our best opportunity to reduce discharge delays for our inpatient population of intermediate care postsurgical patients. In a phased PACU, we would fast-track specific patients to a defined care area designed to support safe recovery. It was staffed with nurses who specialize in the needs of a target population. The phased approach would be supported by multidisciplinary colleagues, including anesthesia providers, physical therapists, social workers, pharmacists and surgeons. We implemented an evidence-based scoring system for patients waking from anesthesia in the OR to help discern proper postsur- Duke University Medical Center, Durham, N.C. TEAM: PeriAnesthesia Care Unit CATEGORY: Best Initiative ENTRY SUBMITTED BY: PACU Team Members gical PACU placement (Phase I or Phase II care). We adopted American Society of PeriAnesthesia Nurses guidelines for staffing ratios and care foci. We reviewed and modified nurse staffing and scheduling to meet the operational needs of the unit. Education was rolled out to the surgeons, anesthesia providers and OR staff, highlighting the goals for the Phase II implementation and evidence-based scoring application. Our PACU Phase II Team also identified and purchased the equipment and supplies necessary for a dedicated Phase II area in the PACU. The Duke University Hospital PACU Team collaborated with numerous interprofessional colleagues. Most importantly, with support from their peers, a core group of Phase II PACU nurses partnered with two anesthesia providers to lead the initiative from inception to implementation. Our multidisciplinary team helped the PACU achieve significant improvements in distinct areas over the course of one fiscal year, based on our preliminary review. We reduced the average recovery time for ambulatory surgery patients and intermediate inpatients by 54%, to 65 minutes. Our Phase II area now cares for more than onethird of our total postoperative volume. And, the projected cost savings of Phase II PACU secondary to decreased length of stay are significant. We estimate that the Phase II PACU initiative has saved more than $1 million so far. Even better, our patient satisfaction scores have not been affected. Our PACU team continues to demonstrate its initiative by pursuing improvements, including the expansion of phased care and the refinement of processes. The nursing members of the Phase II Team developed discharge instructions for patients receiving intraoperative chemotherapy instillations. We continuously review patient feedback and average length of stay by surgical service, then identify areas for improvement initiatives. From the onset of the Phase II PACU plan, our multidisciplinary team has been inspiring to watch. We have demonstrated not only initiative, but also teamwork and interprofessional collaboration. The Duke University Hospital PACU Phase II implementation has helped our service line improve patient throughput, but our greatest accomplishment by far is our PACU’s renewed drive for continuous improvement. n Photo courtesy Duke University Medical Center 16 ADVANCE FOR NURSES n MAY 2016 n www.advanceweb.com/Nurses
Dedicated to IMPROVING EACH PATIENT’S EXPERIENCE Duke Health celebrates the Duke University Hospital PeriAnesthesia Care Unit (PACU) for being selected a 2016 Best Nursing Team by ADVANCE for Nurses. The PACU Team took the initiative to implement phased post-operative care, which significantly reduced the length of stay for our surgical patients, while improving their overall experience. Duke Nurses are valued members of interdisciplinary teams that continually seek to enhance patient outcomes. Through their professional practice, Duke Nurses live our organization’s values of excellence, safety, integrity, diversity and teamwork. In observance of National Nurses Week, we recognize, celebrate and thank Duke Nurses, who deliver patient-centered care throughout our Magnet ® -designated health system, which is comprised of three hospitals, and our home care and hospice services, ambulatory surgical centers, outpatient practices, community clinics, and schools of medicine and nursing. National Nurses Week May 6-12 dukenursing.org | 888-358-2383 U.S. News & World Report Duke University Hospital (#1), Duke Regional Hospital (#8) and Duke Raleigh Hospital (#12) are proud to have been selected as top hospitals in North Carolina by U.S. News & World Report (2015). Duke Raleigh Hospital and selected units of Duke Regional Hospital and Duke University Hospital have been recognized by the NCNA with Hallmarks of Healthy Workplaces. Duke University Health System is very proud to have achieved Magnet recognition (2014).
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