Enhancing Efficiency in Post-Anesthesia Care Unit Discharges: A Non-Clinical Audit Perspective

Prolonged stays in the Post-Anesthesia Care Unit (PACU) can negatively impact patient safety, hospital length of stay, and surgical workflow. While clinical reasons for delayed discharge are often studied, non-clinical factors such as bed unavailability and staff busyness are less frequently addressed. Our objective was to identify non-clinical factors contributing to delayed PACU discharge and implement quality improvement strategies to reduce PACU length of stay.

A new departmental Key Performance Indicator (KPI) was introduced in July 2023 to monitor PACU length of stay, with "delayed discharge" defined as exceeding one-hour post-fitness for discharge. An audit was conducted using retrospective data from 69 patients in September 2023. Two Plan-Do-Study-Act (PDSA) cycles were conducted. Interventions included regular educational sessions, expanding the audit team, initiating monthly departmental quality improvement meetings, creating a new data collection form to assess staff busyness, and adding two beds to the High Dependency Unit (HDU).

Baseline data showed that only 62% of patients were discharged within the target timeframe. After the first PDSA cycle, compliance improved to 74%. Following the second PDSA cycle, supported by multidisciplinary collaboration and infrastructure improvements, the department achieved its target (≥95%) by February 2024. Contributing non-clinical factors leading to delayed discharges included staff busyness (e.g., shift changes, porter delays) and lack of available beds.

Addressing non-clinical factors such as staffing logistics and bed availability significantly improved PACU discharge efficiency. Structured quality improvement initiatives and interdepartmental collaboration were key to achieving sustained improvements in patient flow and departmental performance.