Leipzig case study: PACU*
A fast-track concept which includes aspects of the ERAS programme has been running in Leipzig since 2005, explains Prof. Ender, Senior Consultant in Anaesthesia and Intensive Care Medicine at Leipzig Heart Center. Pointing to the results of a Cochrane analysis5, the Leipzig fast-track concept, in conjunction with risk stratification, seems to offer a promising way to finally reduce post-operative treatment time without endangering patients.
"A 12-hour stint in the recovery room is better than 24 hours."
Among other things, this provides for patients who have undergone cardiac surgery ideally moving from the recovery room* to intermediate care on the same day, then to the normal ward, without spending time in the intensive care unit in most cases.
What started in November 2005 with a recovery room equipped with three beds, is now, with 8 beds, a fixture 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 concept are identified using simple target criteria. These patients were at the top of the operating schedule thanks to pre-selection.
"It is simply worth thinking about the structures", says Prof. Ender, illustrating this with the data from Leipzig.6When the patient comes into the intensive care unit, they are staying 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 randomised 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, and the opportunity to comply strictly with the set protocols.
An evaluation also showed that a 12-hour stint 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.
* Post-Anaesthesia Care Unit, PACU for short (recovery room)