The postanaesthesia care unit as a temporary admission location due to intensive care and ward overflow

With the increasing number of critically ill patients, and shortage of intensive care unit and ward beds, some postoperative patients stay for an unnecessarily long period in the postanaesthesia care unit (PACU), until a suitable bed is available.

We prospectively studied this patient overflow admission to the PACU over 33 months. Four hundred patients with a mean age of 53.1 yr (range 0.2-94) were studied. Two hundred and eighty one (70.3%) patients were mechanically ventilated on admission to the PACU and 311 (77.8%) had invasive monitoring. Mean length of stay in the PACU was 12.9 (SD 10.6) h.

The busiest hours of admission were 01-11 am. Eighteen (4.5%) patients died in the PACU, while waiting for an intensive care unit bed. The main problems were insufficient medical and nursing coverage, and inadequate communication and visiting facilities for patient's families.

Patient overflow to the PACU is a common problem that requires attention. Guidelines for medical and nursing coverage, patient triage, and communication with relatives need to be outlined.