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March 2004, Volume 34 Number 3 , p 19 - 19






    FOR YEARS, the policy in the ICU where I work was to keep all cardiac surgery patients at least overnight, even if they were stable and doing well. Overcrowding in our ICU led us to look for ways to “fast-track” certain patients out of the unit as early as the night of surgery.

    We began by identifying less-acute or elective cardiac surgery patients with the potential to transfer out of the ICU the night of surgery and analyzing the flow of patients through the ICU. Our ICU typically admits the first “wave” (group) of patients between 1000 and 1300; the second wave between 1500 and 1800. We noticed that many patients in the second wave stayed in the ICU only 14 to 16 hours, while those in the first wave tended to stay 22 to 24 hours. We realized that the first-wave patients stayed longer because staff was accustomed to sending patients out of the ICU the following day. This increase in length of stay for ...

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