From Boarding to Flow: Implementing Evidence-Based Interventions to Reduce PACU Length of Stay in a Governmental Hospital.

PURPOSE: To evaluate the impact of a nurse-led, multifaceted quality improvement initiative on reducing post-anesthesia care unit (PACU) length of stay (LOS) and patient boarding in a governmental hospital. DESIGN: Quality improvement study using a Root Cause Analysis (RCA) framework and pre-post intervention evaluation. METHODS: A multidisciplinary team conducted a retrospective review of PACU data over a 12-month baseline period to identify clinical and operational contributors to prolonged PACU stays among boarded patients. Targeted, evidence-based interventions were implemented, including symptom-inclusive discharge criteria, adoption of the Bromage Score for patients receiving spinal anesthesia, enforcement of documentation timelines through a service-level agreement, optimization of staffing mix and rotation, improved communication with bed management, streamlined transfer processes during shift changes, and revision of blood transfusion practices. Outcomes were assessed by comparing PACU LOS, boarding rates, and safety indicators before and after implementation. FINDINGS: Following implementation, substantial improvements in patient flow were observed. The mean number of boarded patients decreased from 716.6 per month at baseline to 129.6 per month three months postintervention. Mean cumulative PACU LOS was reduced from 745.3 h/mon to 215.5 h/mon. Standardized discharge assessment and operational workflow improvements contributed to more timely transfers without increases in postoperative adverse events, unplanned PACU readmissions, or escalation of care. CONCLUSIONS: A nurse-led, system-based quality improvement approach can significantly reduce PACU length of stay and boarding while maintaining patient safety. These findings highlight the critical role of nursing leadership in optimizing perioperative care and strengthening health system efficiency in public hospital settings.