TRANSFERRING INPATIENT MEDICAL PATIENTS HAVING SURGICAL PROCEDURES

1. TRANSFERRING INPATIENT MEDICAL PATIENTS HAVING SURGICAL PROCEDURES Inpt Meets Anesthesia D/C criteria ready for transfer back to floor Parents @ Bedside Arrival in PACU Hand Off Complete Stabilize airway, initial assessment MD to MD H.O. right after surgery (Fellow level) 5” 20” 20” – 35” Total avg time in PACU for Inpts = 45”-60” PACU gets call out from procedure area 15 min prior to procedure ends PACU pages primary team resident to come to the PACU in 15 min for hand off. If during rounds before 10am, primary team should page night float senior resident to attend If during rounds after 10am, primary team senior resident should attend Resident goes to PACU for hand off from surgery/anesthesia, assesses patient, and writes Accept Patient order (see next page) If delay out of procedure area and resident arrives, PACU will call into procedure area for update (not applicable for SHC sites) and send resident in to procedure area if ok with procedural team for hand off (do not delay resident) If non-invasive procedure or SHC provider unavailable, then resident may get hand off from Anesthesia team in PACU In PACU, patient under anesthesia care. Once patient meets PACU D/C criteria, patient will be transferred to floor and care assumed by primary team. Primary team to be paged once patient arrives on floor. Resident to mark Audit Board in PACU as appropriate (see next page) If primary team doesn’t arrive in time for hand off in PACU, then the PACU RN will initiate andon process as described below Andon Process Escalation 1: If primary team doesn’t arrive for hand off from procedure area, then PACU RN will insure patient airway stabilized, complete initial assessment, and then page primary team Standard text: Pt A. ready to return to floor in 15”. Enter Accept orders and contact surgical team for sign out If no response or no orders entered within 15” then bedside PACU RN escalates to PACU RSN Escalation 2: PACU RSN to text primary team Fellow If no response or orders entered within 15”, then PACU RSN escalates to Perianesthesia Services ANM Escalation 3: ANM to text primary team Attending Owner: W Yick (wyick@lpch.org) V1: 20 Sept 12

2. How to Enter Accept Patient Order • Enter “accept” in the Search field • Click on the “Accept Patient” order set and complete as applicable • Enter free text comments: “OK to transfer pt once PACU d/c criteria met. Primary team will assume care once arrives on floor. Page primary team on arrival to floor.” Auditing the Process to Identify Gaps and Recognize Success • Resident to track their process in PACU • Please add comments for what worked and/or didn’t work for you in the process • If you came and the patient hasn’t arrived please put a red magnet in the column “Resident arrived but patient not in PACU” • If you met the standard and participated in hand off please put a green magnet in the column “Standard Met”