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Hospitals across the country continue to see historically high inpatient volume. At Brigham and Women’s Faulkner Hospital, creative thinking has allowed caregivers to manage the demand. Adding to the issue is a backlog of surgical patients whose procedures were delayed due to the pandemic but are not able to be delayed any longer. Recently, a solution was found when the hospital opened its Extended Recovery Unit (ERU).
Under the new model, patients who meet certain criteria can stay overnight in the Post-Anesthesia Care Unit (PACU) and be discharged early the next morning before that day’s surgical patients arrive. That means they never need to be transferred to an inpatient bed.
“Over the last few years, we have had an increasing number of patients who are appropriate for same-day discharge. This includes patients who have joint replacements, mastectomies and prostatectomies,” says Associate Chief Nurse for Perianesthesia, Procedural and Ambulatory Services Robin Kaufman, DNP, APRN, FNP-C, NEA-BC. “We use guidelines including American Society of Anesthesiologists Classification as well as other factors to determine if they are a good candidate for this pathway.”
That process begins long before a patient arrives on the day of their surgery. Kaufman explains, “Even before a patient has their pre-op evaluation appointment, expert nursing staff evaluate upcoming surgical patients and utilize a check list tool in the medical record where they make a notation that they might be appropriate for our ERU. That sets the process in motion.”
If an upcoming surgical patient is flagged by the ERU team, which is made up of paranesthesia nurses, the patient will be evaluated further during their pre-operative evaluation appointment and, if they are deemed appropriate, be given details about the ERU. On the day of their surgery, the entire care team is aware of the plan and ensures the patient has everything they need for a safe and successful outcome.
“We thought a lot about the patient experience. In fact, we enlisted our Patient and Family Advisory Council very early in the process to help us design a care plan that would be efficient and comfortable for our patients,” says Kaufman. “Because the ERU has beds separated by curtains, we’ve developed a care package that includes a sleep mask and ear plugs and we take extra care to ensure patients can easily access their streaming entertainment services on their devices while they are with us.” According to Kaufman, patient feedback is showing that many of them appreciate being discharged by 9 am and the exceptional collaboration between members of the team to make everything run seamlessly.
What’s been most impressive for Kaufman has been watching the multidisciplinary care team come together to make it happen. “I could not be more proud of my Perioperative Department Clinical Leadership Group and my other staff who really took ownership of designing this unit and putting the new processes in place. Our whole BWFH team worked together,” says Kaufman.
Ultimately the ERU is about providing the right level of care, in the right place, at the right time. The ERU is ideal for patients who are appropriate for same-day discharge, but perhaps have their surgery scheduled too late in the day to go home that evening. Rather than move from the Operating Room to the PACU and then to the inpatient unit, they can recovery comfortably in the PACU and know they will be on their way home first thing in the morning. And for the patients who do need a higher level of care, it’s reassuring to know that more inpatient beds are available to provide the care they need.
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