Open Access Open Access  Restricted Access Subscription or Fee Access

Strategies to maintain operating room functionality following the complete loss of the recovery room due to an internal disaster

Elise C. Metzler, MD, Bhavani S. Kodali, MD, Richard D. Urman, MD, MBA, Hugh L. Flanagan, MD, Monica Sa Rego, MD, Joshua C. Vacanti, MD


The post-anesthesia care unit (PACU) is a major contributor to the operating room (OR) process flow and efficiency. A sudden failure of hospital facility infrastructure due to a burst pipe resulted in the complete loss of a 66-bed combined preoperative and PACU facility of a major academic medical center. The OR suites were undamaged. The clinical and administrative challenges of caring for surgical patients without the usual preoperative and postoperative care areas are discussed. Our strategy for maintaining OR functions and management of patient flow, OR personnel, case prioritization, and equipment needs are detailed from the time of initial crisis until restoration of these clinical care areas. Utilization of the hospital disaster Incident Command Structure and the activation and decision support provided by the hospital Emergency Operations Center (EOC) for the week immediately following the crisis, helped maintain OR functionality.


post-anesthesia care unit (PACU), Incident Command Structure, internal disaster, flooding

Full Text:



Federal Emergency Management Program: Incident Command Structure. Available at Accessed September 20, 2014.

Gawande A: Why Boston's hospitals were ready. The New Yorker.

April 17, 2013.

Bell C: Operating Room Design Manual. Schaumburg, IL: American Society of Anesthesiology, 2012: chap 14. Available at Accessed September 20, 2014.

Yarborough MJ, Liu H, Bent S: Postanesthesia care unit management. In Kaye AD, Fox C, Urman RD (eds.): Operating Room Leadership and Management. 1st ed. Cambridge: Cambridge University Press, 2012: 186-193, chap 18.

Dexter F, Macario A, Manberg PJ, et al.: Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg. 1999; 88(5): 1053-1063.

Schoenmeyr T, Dunn PF, Gamarnik D, et al.: A model for understanding the impacts of demand and capacity on waiting time to enter a congested recovery room. Anesthesiology. 2009; 110(6): 1293-1304.

Dexter F, Epstein RH, Marcon E, et al.: Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms. J Perianesth Nurs. 2005; 20(2): 92-102.

Ehrenfeld JM, Dexter F, Rothman BS, et al.: Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit. Anesth Analg. 2013; 117(6): 1444-1452.

Marcon E, Kharraja S, Smolski N, et al.: Determining the number of beds in the postanesthesia care unit: A computer simulation flow approach. Anesth Analg. 2003; 96(5): 1415-1423, table of contents.



  • There are currently no refbacks.