MORGANTOWN, W. Va. – In medical emergencies, seconds count. In the Post Anesthesia Care Unit (PACU), minutes count when it comes to providing a smoother process for patients, their families and clinicians.
A collaborative partnership between the West Virginia University School of Nursing graduate-level students and administrators at WVU Medicine Golisano Children’s is focused on identifying clinical opportunities for improvement, implementing evidence-based solutions and enhancing patient outcomes. Among the objectives is reducing the wake-up time for surgical patients.
When Hilary Findo, a recent graduate of the Doctor of Nursing Practice (DNP) Nurse Anesthetist program, was presented with the idea for her Quality Improvement Project, she knew she wanted to cover it from all angles. As a mother of two young children, an ICU nurse for nearly 15 years and a student, she knows the importance of reducing recovery time.
“I’ve had a child go through same-day surgery and seeing that now through a different lens, as a student in anesthesia, I can see that these quality improvements can be small and still affect the overall outcomes for patients and facilities,” said Findo, who is also a graduate of the Bachelor of Science in Nursing (BSN) program. “I think the DNP students are really well positioned to lead these because this is what we’re learning.”
DNP Nurse Anesthetist students and post-masters DNP students are required to complete a culminating project that combines their newly acquired competencies achieved through the coursework and clinical experiences. The projects are designed to positively influence healthcare outcomes by changing or improving systems to address a clinical need.
“Hilary’s project is an excellent example of how DNP-prepared APRNs are positioned to lead meaningful system-level changes that improve outcomes for patients and families,” said Dr. Billie Vance, Director of the Evidence-Based Practice and Quality Improvement. “It represents not only an important contribution to the children’s hospital, but also the foundation for the lasting impact that these future nurse leaders will continue to make throughout their careers.”
“It was a really good perspective for me in the final years of my DNP schooling because it gave me that full circle moment to understand how important it is for health systems to be doing quality improvement and continuously staying up on evidence and making sure their practices are the best they can be for their patients,” Findo said.
Findo’s project involved gastroenterology pediatric same day procedure patients, ages 2 to 10, who had undergone a diagnostic scope.
“In the background information for the request, they gave an average of 33 minutes for Phase 1 recovery, which is from the time they are handed off in the PACU to the time where they had an Aldrete score of at least 8, meaning they can be removed off oxygen and can sit up and have something to drink,” Findo explained. “Leaders in the Anesthesiology Department ty were wanting to reduce the recovery time to 30 minutes without increasing post-operative agitation, pain or any side effects of an increased recovery.”
In addition to reducing recovery time, Findo’s project aimed to engage at least 75% of the anesthesia providers in each cycle and ensure there was no increase in patients’ emergence agitation — behavior such as confusion, crying or combativeness that occurs in post-anesthesia.
After reviewing medical literature, she formulated a set of guidelines with the help of Best Evidence and Certified Registered Nurse Anesthetists working with her as project coordinators. A panel of experts participated in a modified Delphi questionnaire to ensure a consensus among top pediatric providers.
Focusing on the two main anesthetic techniques, Sevoflurane or propofol, Findo didn’t consider one over the other, but instead targeted ranges per weight and bolus dosing per weight.
After completing outreach and education with anesthesia providers, Findo set up the guidelines for providers in one of the GI procedure rooms and tracked adherence versus non-adherence and recovery times through three Plan-Do-Study-Act (PDSA) cycles for a total of 33 rounds.
In the first cycle, Findo captured 44% adherence to the guidelines, prompting her to slightly modify those for the next phase. In the second cycle, the adherence rate reached nearly 70%.
When anesthetists were adherent to Findo’s guidelines, the mean recovery time was at or below the 30-minute benchmark. Findo says that while saving three minutes seems like a small feat, it can enhance a full day of PACU patient flow.
“Minutes are important for the PACU as a whole and also from the patient and family perspective because even just a couple minutes delay on each patient can really cause bottlenecks and decrease patient experiences,” she said.
Throughout the project, there was no increase in emergence agitation among the children.
While she was pleased with the clinically significant outcomes, Findo thinks the work can evolve with other DNP students continuing the project by including workflow variables.
“Future efforts for this initiative can focus on strengthening adherence, expanding to other procedure rooms and evaluating long-term outcomes and sustained practice of the anesthesia guidelines for same day GI patients,” she said.
Findo made a visual presentation of her results to the West Virginia Association of Nurse Anesthesiology Spring Meeting in Morgantown.
“The lesson I’ll carry forward when I’m in practice as a CRNA is that what I do in the operating room doesn’t end when I extubate the patient and take them to PACU,” Findo said. “What I do shapes their recovery outcomes and it’s not just for me. It’s not just for the system. It’s not just for the patient. It’s not just for the family. It’s for all of them.”
-WVU-
ls/9/9/2026
MEDIA CONTACT: Wendy Holdren
Director of Communications and Marketing
WVU School of Nursing
304-581-1772; wendy.holdren@hsc.wvu.edu