ICU patients can be monitored in the PACU with appropriate staffing, but the CMS does not reimburse the facility in this scenario as an observation patient. Patients who are kept as overflow patients in the PACU are often referred to as “boarders,” “extended stay,” or “ICU overflow” (Odom-Forren, 2013).
Staffing the ICU overflow patient in the PACU presents a challenge. If the patient is stable, the nurse may have another patient assigned to his or her care. As recommended by the 2014 ASPAN standards and ICU staffing ratios using the California ratios, the PACU nurse should have no more than two patients at any time (ASPAN, 2014; California Nurses Association, 2004).