Leipzig Heart Center case study: Post-Anesthesia Care Unit (PACU)
"The concept can only succeed when everyone is on board."
A fast-track concept which includes aspects of the ERAS program has been implemented in Leipzig since 2005, explains Prof. Ender, Senior Consultant in Anesthesia and Intensive Care Medicine at Leipzig Heart Center. Pointing to the results of a Cochrane analysis5, the Leipzig fast-track program, in conjunction with risk stratification, seems to offer a promising way to finally reduce post-operative treatment time without risk to the patients.
Based on this program, patients who have undergone cardiac surgery ideally move from the recovery room to the intermediate care on the same day. Following this they are transferred to the normal ward, without spending time in the ICU (Intensive Care Unit) in most cases.
What started in November 2005 with a recovery room equipped with three beds, is now a fixture with 8 beds in the Heart Center. Internal statistics show that in the first year, just 18% of cardiac surgery patients received post-operative care via this route, while in 2019 the figure was over 52%. This currently corresponds to nearly 20,000 patients. Those who are suitable for the fast-track program are identified using simple targeting criteria and prioritized in the operating schedule.
"It is simply worth thinking about the structures", says Prof. Ender, illustrating this with the data from Leipzig.6 When the patient comes into the intensive care unit, they stay overnight, regardless of whether or not they have been extubated. Some of the reasons for this are logistical.
Data from a follow-up trial also showed promising results.7 The randomized controlled trial confirmed the earlier results and, for fast-track patients, showed a significant reduction in extubation time, ventilation time, duration of stay (PACU vs. ICU) and a lower incidence of arrhythmia.
For Prof. Ender, the differences were mainly due to:
- adequate staffing, i.e. better staff-to-patient ratio in the recovery room.
- the possibility to strictly comply with the set protocols.
An evaluation also showed that a 12-hour shift in the recovery room is better than 24 hours, which is why opening hours are limited to 12 hours per day.
And finally, teamwork is important. "The concept can only succeed when everyone is on board," concluded Prof. Ender.