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The Effect of Direct-From-Recovery Room Discharge of Laparoscopic Cholecystectomy Patients on Recovery Room Workload

Bjørn Andersen, MS, PhD

Department of Production and Quality Engineering, Norwegian University of Science and Technology, Trondheim, Norway

David L. Berger, MD

Department of Surgery, Harvard Medical School and Massachusetts General Hospital Boston, Massachusetts

Suzanne M. Sokal, MSPH

Department of Surgery, Massachusetts General Hospital Boston, Massachusetts

Warren S. Sandberg, MD, PhD

Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Clinics 3, Boston, MA 02114; wsandberg{at}partners.org

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.

Key Words: ambulatory surgery • perioperative systems design • OR economics • laparoscopic cholecystectomy • PACU workload

Surgical Innovation, Vol. 13, No. 4, 257-264 (2006)
DOI: 10.1177/1553350606297053


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