A project was proposed for recovery of patients after anesthesia that would provide patient-centric care with higher efficiency and improved resource management. By identifying a subset of patients undergoing specific surgeries or procedures, the department of anesthesiology sought to decrease the amount of time patients spend in the high intensity, labor-intensive Phase I of Post Anesthesia Care Unit (PACU) recovery, by instituting an alternate pathway, known as Fast Track.

As part of the Quality Improvement Performance Evaluation protocols, they realized that while most of the patients were having complex surgeries requiring general anesthesia and needing labor and resource intensive phase I PACU recovery, approximately 15-20% of the cases were of the nature that phase I PACU recovery may be unnecessary. By accurately identifying these types of cases and patients, there was the potential to improve efficiency, decrease the amount of duplicate charting, allow patients to be discharged faster, while being cost effective for the healthcare system. After a thorough literature review, two main areas were identified where Fast Track would be appropriate: 1) patients having minimally invasive endoscopy/colonoscopy and 2) patients undergoing surgery for cataracts.

Overall, the Fast Track program was a resounding success. An audit of one month of the program, reviewing all pertinent case types, demonstrated that 94.7% outpatients presenting for Gastroenterology procedures were able to bypass phase I of PACU after implementation of the revised workflow. For 2020, this would correspond to 1033/1100 outpatients bypassing phase I of recovery. Similarly, 97.5% of patients in the audit period presenting for cataract surgery were able to bypass phase I of PACU recovery. For the year of 2020, this would correspond to 445/461 patients bypassing phase I of PACU recovery.  They were able to identify a theoretical cost saving to the healthcare enterprise of $7.39 per case. This translates to a cost saving to the healthcare system of $10,922 for the year by simply implementing a change in workflow for selected patients and cases receiving anesthesia care. There were no known complications that occurred in the patients who bypassed phase I of PACU recovery.