PACU initiative cuts emergency response times from 9 to 2 minutes

Editor's Note

A multidisciplinary quality improvement effort at Vanderbilt University Medical Center sharply reduced response times to post-anesthesia care unit (PACU) emergencies, demonstrating a model that other hospitals could replicate, OR Management News September 1 reports. By combining education, clear role identification, standardized anesthesiologist notification, and recurring mock code drills, the initiative brought average response times down from more than 9 minutes to just 2.

The program began after staff turnover in 2023 revealed gaps in emergency response efficiency. Internal reviews of mock codes showed delays in assembling teams and clarifying roles. In response, anesthesiologists and nurses developed targeted interventions. These included training sessions on emergency activation processes and equipment, role-specific stickers applied during codes to streamline identification, and structured debriefings after mock events. Role stickers, in particular, were described as a surprisingly effective tool to improve team coordination.

Another key innovation was the creation of weight-based code-dosing sheets for all perioperative patients, not just inpatients. These bedside printouts list individualized emergency drug dosages, an especially valuable resource in pediatric cases where rapid dosing accuracy is critical. The sheets are now a routine part of patient intake.

At the 2025 International Anesthesia Research Society annual meeting, lead investigator Christy Crockett, MD, reported response times improved immediately after implementation and sustained the 2-minute benchmark over 12 months, supported by ongoing mock codes held every 8 weeks. Survey data also showed substantial gains in staff confidence and preparedness, with notable improvements in role clarity, code initiation knowledge, and comfort assuming responsibilities.

Experts believe the results offer a blueprint for other facilities. Patrick McCormick, MD, MEng, of Memorial Sloan Kettering Cancer Center, noted the PACU is a uniquely complex critical care setting, where rapid team coordination is essential. He emphasized while implementing such programs can face institutional and cultural hurdles, Vanderbilt’s model proves that relatively simple interventions can drive measurable improvements. He also suggested expanding the mock code framework to include role-specific training modules and better integration with electronic medical record systems for automated notifications.