Improving Patient Flow in Critical Care:  Development of a Post Anaesthetic Care Unit with “Simultaneous Virtual ward admission”.

Background
There are clear challenges facing critical care provision in Wales.  Capacity is amongst the lowest in Western Europe.  This problem is compounded by a significant loss of critical care bed days due to delayed discharges (7.5% of total critical care bed days in 2012/13).  Consequently critical care occupancy rates are consistently >80%, leading to, significant numbers of high-risk operations being cancelled.

All patients admitted to the PACU at the Royal Gwent Hospital, Newport are simultaneously admitted to a ward.  As such they “virtually” occupy a ward bed, ensuring timely discharge from critical care.  We aimed to determine if the introduction of a PACU with this novel admission process has reduced cancellations of high-risk surgery.

Methods
We conducted a retrospective analysis of patients for whom a critical care bed had been booked electively at the Royal Gwent Hospital, Newport.  All cases were examined to determine if the procedure had been cancelled and if so the reason for cancellation.  Data was examined for the period April – October for 2012-2014.  This was then compared to the same period in 2015 when a PACU was operational.  

Additional ICU case mix analysis was conducted using ICNARC national audit data.

Results
The demand for critical care to facilitate high-risk surgery increased year on year with 138% more critical care beds booked in 2015 than in 2012. Despite this the introduction of the PACU markedly reduced the percentage of these procedures cancelled due to a lack of critical care beds from 28% in 2014 to 1% in 2015.

The proportion of total admissions, constituted by patients admitted after elective surgery also increased from 18% in 2014 to 30% in 2015.  This figure was higher than the national average of 22.9%.

Conclusion
This study demonstrates that the introduction of a PACU with simultaneous virtual ward admission can markedly reduce cancellations of high-risk surgery and significantly impact on the case mix of an ICU.  Further work should include cost effectiveness analysis.

References 
Together for health-A Delivery plan for the critically ill (2013)

Improving Patient Flow in Critical Care: Development of a Post Anaesthetic Care Unit with "Simultaneous Virtual Ward Admission