The recovery room as an intensive care unit

Introduction

Beds in intensive care units (ICU) are expensive and their number is limited. Unstable mechanically ventilated and postsurgical, patients, sometimes have to be treated outside an ICU, due to lack of an available open bed. In our hospital these patients are treated at the recovery room (RR) until a bed is available in the ICU. We prospectively studied the admission of acute care patients to the RR.

Methods

Patients who where admitted to the RR between March and June 1997 were studied. Patients were included if they were assigned to an ICU either before or during surgery, but could not be admitted due to lack of space. Primary medical and nursing care was provided by the anesthesiologists and the RR nursing personnel.

Results

Forty-three patients were included in the study. Mean (± SD) age was 51 ± 25 years. Thirty-seven patients (86%) were emergency room admissions, 6 of whom did not require surgery.

Duration of stay in the RR was 18 ± 17.6 h (median 12, range 2.5–97). All patients were intubated and mechanically ventilated, and had a central venous and an arterial lines on admission to the RR. Thrity-nine patients (90.7%) were still intubated on transport to the ICU. Three (7.0%) patients were children, ages 6, 7, 15. One patient died in the RR. Eight patients (18.7%) were assigned the medical/surgical ICU, 25 (58.1%) to the neurosurgical ICU, three (7.0%) to the pediatric ICU and seven (16.2%) to other locations.

Discussion

The RR with its monitoring equipment, nursing and anesthesia personnel is an attractive location to treat these patients. The following limitations were noted: 1. No additional nursing staff was provided. Therefore less attention could be paid to the `routine' postoperative patients. 2. The space in our RR is limited and at times immediate postoperative patients had to be delayed in the operating room (OR). This way the yield of OR use was decreased. 3. The primary surgical services tended to lessen postoperative rounds at their RR patients, and communication with them was less than optimal.

Conclusion

While acute care patients can safely be admitted to RR, the duration of their stay should be as short as possible.