Patient Expectations about PACU Stay: Implications in Instituting Timely Discharge
Mary Ann Vann, MD, Stephen A. Cohen, MD, MBA
Department of Anesthesia, Critical Care and Pain Medicine,
Beth Israel Deaconess Medical Center, Boston, MA 02215

Introduction
Successful ambulatory surgery facilities emphasize the importance of discharging patients to home in a safe, efficient, and timely manner. The Modified Post Anesthesia Discharge Scoring System (MPADSS) often serves as a tool to assess home readiness. The application of the MPADSS criteria may not guarantee the timeliest discharge, however. For example, it has recently been shown that patients allowed to discharge themselves after minor gynecological procedures under general anesthesia went home an average of 13 minutes faster than those discharged by the nursing staff utilizing MPADSS criteria.1 Although we
use the MPADSS to assess discharge, our institution developed time targets for ambulatory patient PACU length of stay. While we have made considerable progress in attaining these goals, we do not consistently meet them. We hypothesized that patient expectation about their length of stay played a role in their actual time to discharge. We also wanted to know what factors contributed to patient expectations. Hence, we designed and implemented a quality assessment survey of our patient’s impressions on their PACU length of stay.
Methods
Patients were asked to complete a five-question multiple choice quality assessment survey in Phase II PACU once they were eligible for discharge according to our PACU’s MPADSS criteria. The survey addressed the patients’ impressions of the length of stay, the nature and origin of their expectations, their personal beliefs about an outpatient stay, and how they felt as they left the facility. We asked the Phase II nurses to hand the survey to patients when they were eligible for discharge. The patients were instructed to fold the survey and deposit it in a sealed box at the nursing desk.
Results
Over an eleven-day period, 233 completed surveys were collected. This number represents approximately half of the ambulatory patients having surgery in one set of operating rooms at our facility during this period. To be included, the respondent must have answered the first question (“Was the length of your PACU stay: Too short, Too long, Just right?”). Two hundred twenty two patients responded that their length of stay was “just right.” Only four and seven patients indicated that their stay was “too short” or “too long,” respectively. Just three patients felt that they were rushed out of the hospital and four that they were
delayed from returning home. The remaining 218 patients based their opinion about appropriate length of stay on their expectations. We intended the survey to guide our patient education efforts on expected length of stay after ambulatory surgery. However 48 patients responded that they had no expectation about their length of stay. The most common basis for information on PACU length of stay came from the surgeon (72 patients). Forty-two patients developed their expectation from nurses before the day of surgery, in the PAT clinic or on a preoperative phone call. Another 28 patients based their expectation on information given to them by nurses on the day of surgery. Forty-nine patients based their expectations on personal experience with previous surgical procedures. Only three patients relied on family members for their expectations, and three based their expectations on media, the Internet, something they read, or saw on television. Two hundred seven patients indicated that they always felt better at home or did not like to spend any extra time in the hospital. One hundred ninety two felt good when discharged.
Discussion
We found considerable uniformity of opinion among our patients along several responses. Most strikingly, nearly all thought that their length of stay in the PACU was just right. The results were surprising and have made us reconsider further our approach to decrease PACU stays and meet our patient’s needs. This presents a challenge because we will have to educate a larger number of persons (e.g. patients, surgeons, nurses) than we originally thought. We will have to continue to monitor our patients’ satisfaction as we make systemic changes to try and further decrease length of stay. Methodological reasons may have led to errors in our results. For example, some nurses may not have distributed the questionnaire to certain patients, or some patients may not have felt well enough to complete even such a simple survey. That the vast majority of patients responded that they feel better at home than in the hospital and that they do not like to spend any extra time in the hospital suggests that we will ultimately meet and surpass our institution’s targets.
Reference
1. Harow EE, Vardi M, Evron S, Sessler ID, Tiberiu E. Patient-Controlled Discharge from an Ambulatory Surgical Unit. Anesthesiology 2004; 101: A36.

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