Enhancing Surgical Recovery and Inpatient Flow Using a PACU-Based Rapid Recovery Unit

The Rapid Recovery Unit (RRU) was developed to optimize perioperative patient flow, support postoperative disposition, and improve resource utilization by providing short-term, high-acuity monitoring within the Post-Anesthesia Care Unit (PACU) for surgical patients anticipated to require intensive observation for 48 hours or less.

This quality improvement project utilized a retrospective, descriptive design to evaluate implementation of an RRU embedded within the PACU. The initiative evaluated whether a short-stay, high-acuity care model could support management of select postoperative patients who might otherwise require higher levels of care while maintaining patient safety. The target population included surgical patients requiring advanced monitoring following complex or high-risk procedures. Key outcomes included patient disposition, resource utilization, and escalation of care.

Data from 64,356 surgical cases over a five-year period were extracted from institutional perioperative databases. Analyses focused on patients admitted directly to the RRU. Patients were evaluated for postoperative disposition and safety outcomes, including differences between planned and actual level of care. Descriptive statistics were used to summarize patient disposition, resource utilization, and unplanned escalation events.

Of 64,356 surgical cases, 8,870 patients (13.6%) were admitted directly to the RRU. Within this cohort, 3,204 patients were discharged to a lower level of care than initially planned, while 397 required escalation relative to preoperative expectations. At discharge, 2,939 patients were discharged home, and the remainder required inpatient care. A total of 632 patients experienced unplanned escalation to a higher level of care during their RRU stay (7.1% of RRU cohort; approximately 1% of total cohort). Additionally, 412 cases (4.6%) experienced operating room holds.

A PACU-based, short-stay, high-acuity care model may support perioperative throughput and facilitate alignment between anticipated and actual postoperative levels of care. The RRU represents an intermediary level of care that leverages perioperative nursing expertise and interprofessional collaboration to support patient flow while maintaining safety. This model may provide a practical approach to preserving ICU capacity in high-volume surgical settings.