Outcomes of patients admitted to the Intensive Care Unit after Postanesthesia Care Unit boarding
Authors: Kiekkas Panagiotis , Gklava Vasso , Bellou Aggeliki , Fligou Fotini , Tzenalis Anastasios , Igoumenidis Michael , Aretha Diamanto 
Published: December 2024

Objective: This study aimed to investigate the associations of delayed admission to the intensive care unit (ICU), due to the boarding of critically ill patients in the postanesthesia care unit (PACU), with patient outcomes.
Background: Previous literature has provided conflicting findings about whether delayed admission to the ICU is associated with suboptimal patient care and worsened outcomes. In the limited studies on ICU patients boarded in the PACU, their ICU mortality, hospital and ICU length of stay, and duration of mechanical ventilation did not differ significantly when compared with those of patients directly admitted to the ICU.
Study design and methods: This was a single-centre, prospective, observational study. Patients consecutively admitted to the ICU from January 2021 to May 2023 were enrolled. Recorded data included patient demographics, clinical severity, multi-organ dysfunction and comorbidities, and the duration of PACU boarding. Adverse patient outcomes included prolonged duration of mechanical ventilation, prolonged ICU length of stay, incidence of infections and mortality during ICU stay. The associations between PACU boarding and its duration and adverse patient outcomes were evaluated with univariate comparisons and multivariate analyses.
Results: Two hundred thirty ICU patients were enrolled, with 83 (36.1%) of them being boarded in the PACU. Median duration of PACU boarding was 72.0 (48.0-144.0) hours, with 51 (61.4%) patients staying for > 48 hours. Patients with delayed admission to the ICU were more likely to be diagnosed with surgical wound infection (p = .023), but less likely to be diagnosed with pneumonia (p = .008) compared with those with direct ICU admission. However, in the multivariate level, no significant associations were detected between PACU boarding and its duration and adverse patient outcomes.
Conclusion: Delayed admission to the ICU after PACU boarding was not associated with worsened patient outcomes, which supports the competence of PACU nurses in caring for the critically ill.
Implications for practice: These findings add to the existing evidence that the PACU can be used safely in case of ICU bed shortages.
What is already known about the topic?

The majority of the existing studies have indicated that delayed admission to the ICU of adult patients is associated with higher mortality, while prolonged ICU and hospital length of stay have also been reported.
Delayed admission to the ICU may not be translated into suboptimal patient care in case critical care monitoring and treatments are provided outside the ICU.
Boarding of critically ill patients in the PACU has not been associated with adverse outcomes, except for higher ICU mortality in case boarding duration was long.

What this paper adds

PACU boarding was not associated with prolonged duration of mechanical ventilation, prolonged ICU LOS, infections and ICU mortality of patients.
Even long duration (> 48 hours) of PACU boarding was not associated with worsened patient outcomes compared with direct admission to the ICU.
The PACU can be used safely as a temporary admission location for ICU overflow patients.