Impact on Health Outcomes of Boarding Postoperative Critically Ill Stable Older Patients

Background: Optimizing patient flow can be one of the greatest challenges for nurse leaders in tertiary referral hospitals. It is essential to implement best processes to enhance the patient flow, to maximize bed availability and avoid boarding.;Purpose: To evaluate the impact of PACU boarding on the health outcomes of critically ill stable older postoperative patients waiting for an ICU bed.;Methods: This was a case-control study that used secondary data from the Project IMPACT Database populated between 2002 and 2010 in a tertiary referral safety net institution. A total of 145 patients age 65 to 85 years of age who were boarded in the PACU (> 6 hours) were matched 1:1 on admission year and gender to patients who were recovered (< 6 hours [control group]) in the PACU (total sample 290 patients, 145 pairs).;Results: The average age of patients was 73 years, 53% were male, and were predominately White (71%). Hospital LOS (20.26 days + 37.2 days) was longer for boarded PACU patients than the control group (14.72 days + 13.55 days) which was clinically relevant (5.5 days) but not statistically significant (p = 0.054). As hypothesized, there was no statistically significant difference between those who boarded in the PACU or recovered in the PACU in terms of postoperative LOS, decline in functional status and hospital mortality. However, postoperative LOS was also clinically relevant with PACU boarders spending on average 4.5 days longer in the hospital than the control group (17.10 + 34.64 versus 12.60 + 12.47 respectively). When controlling for age and race with a postoperative LOS > 9 days, PACU boarders were 1.7 times (95% CI: 1.054-2.767, p = 0.03) the odds of having a longer postoperative LOS than the control group.;Conclusions: Further research is needed to identify contributing factors associated with prolonged postoperative LOS in those critically ill older stable surgical patients who board in the PACU after surgery. Nurse leaders responsible for patient flow may also need to consider the potential financial implications of boarding along with quality of care metrics. Key Words: PACU boarding, health outcomes, patient flow.