Sandberg Warren S, Canty Timothy, Sokal Suzanne M, Daily Bethany, Berger David L
Harvard Medical School and the Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Mass 02114, USA.
Surgery. 2006 Sep;140(3):372-8. doi: 10.1016/j.surg.2006.02.007.
We assessed the operational and financial impact of discharging laparoscopic cholecystectomy (LC) patients directly from the postanesthetic care unit (PACU) in comparison with post-transfer discharge from a hospital bed in a busy academic hospital.
We retrospectively compared 6 months of performance (bed utilization; recovery room and hospital length of stay; complications; readmissions; hospital costs, revenue, and margin) after implementation of PACU discharges (case patients) to the corresponding 6 months in the prior year (control patients).
After implementation, 66% of LC case patients were discharged on the day of surgery, compared with 29% in the control group (P < .05). Eighty percent of the day-of-surgery discharges were directly from the PACU. Shifting to PACU discharge saved 1 in-hospital bed transfer and 1 bed-day for each PACU discharge. Recovery room length of stay for PACU discharge patients was 26% longer than for hospital discharge patients (P = NS). Average hospital length of stay for all patients discharged on the day of surgery was 3.2 hours shorter (P < .05) for case patients (80% PACU discharge) than for control patients. There were no readmissions in the PACU discharge group and no difference in complications. While costs, revenue, and net margin for PACU discharge patients were reduced by 40% to 50% (P < .02) relative to floor discharge patients, the hospital's net margin for the combined case patient group was preserved relative to the control group.
PACU discharge of LC patients significantly reduces bed utilization, decreases in-hospital transfers, and allows congested hospitals to better accommodate patient care needs and generate additional revenue.
我们评估了在一家繁忙的学术医院中，与从医院病床转至麻醉后监护病房（PACU）后出院相比，直接从PACU出院的腹腔镜胆囊切除术（LC）患者的手术操作和财务影响。
我们回顾性比较了实施PACU出院（病例患者）后6个月的表现（床位使用情况；恢复室和住院时间；并发症；再入院情况；医院成本、收入和利润）与上一年相应的6个月（对照患者）。
实施后，66%的LC病例患者在手术当天出院，而对照组为29%（P <.05）。手术当天出院的患者中有80%直接从PACU出院。转向PACU出院，每次PACU出院节省了1次院内床位转移和1个床日。PACU出院患者的恢复室停留时间比医院出院患者长26%（P =无显著性差异）。手术当天出院的所有患者中，病例患者（80%从PACU出院）的平均住院时间比对照患者短3.2小时（P <.05）。PACU出院组无再入院情况，并发症无差异。虽然PACU出院患者的成本、收入和净利润相对于病房出院患者降低了40%至50%（P <.02），但病例患者合并组的医院净利润相对于对照组得以维持。
LC患者从PACU出院可显著降低床位使用率，减少院内转移，并使拥挤的医院能够更好地满足患者护理需求并增加额外收入。
