Improving surgical patient flow in a congested recovery area

Abstract

The recent movement in healthcare reform requires hospitals to care for more patients while simultaneously reducing costs. Medical institutions can no longer afford to simply add beds and hire staff to increase capacity. They must use existing resources more effectively and develop innovative solutions to increase capacity. This project focuses on the redesign of surgical patient flow through multiple Post-Anesthesia Care Units (PACUs) at Massachusetts General Hospital (MGH). The PACU is where surgical patients recover following their procedure that takes place in the Operating Room (OR) suite. Some patients experience delays when leaving the OR due to the lack of a staffed PACU bed. These patients begin the recovery process in the OR which causes delays for to-follow cases. In addition, the OR nursing staff rather than a PACU nurse must monitor recovery, which drives higher costs and frustrates staff members. Therefore this study examined the sources of delay and sought to redesign the flow of surgical patients through the PACUs. Our main recommendation is to incorporate a "Fast Track" for the outpatient population that eliminates delays and expedites outpatient processing in the PACU. Segregating the outpatients and implementing the one-stop "Fast Track" recovery process will reduce average outpatient PACU length of stay (length of stay) by 27%, the equivalent of adding 1.8 beds of capacity. Through the application of operations management techniques, we can decrease the patient processing time or length of stay in the PACU, which in turn increases throughput and creates additional capacity.