Extended recovery room as a strategy to reduce inappropriate ICU admissions: an Italian hospital experience

The limited operational hours of Recovery Rooms (RR) frequently result in potentially avoidable intensive care unit (ICU) admissions for intermediate-risk surgical patients. "Project Futura," implemented at Santo Stefano Hospital (Prato, Italy) in March 2024, extended RR hours into the evening (until 24:00) and holidays by reorganizing existing ICU nursing staff without additional resources. This retrospective before-after study compared October-December 2023 (pre-intervention) with October-December 2024 (post-intervention). During the post-intervention period, 362 of 1519 surgical patients (23.83%) received extended RR monitoring; only 18 (1.18%) required subsequent ICU/intermediate care unit admission. ICU occupancy decreased from 91.79 to 73.78% (p < 0.0001), extraordinary emergency RR activations dropped from 22 to 0, estimated ICU costs decreased by 35.7%, and nursing on-call hours were reduced by 91.7%. These preliminary findings suggest that extending RR operational hours may represent a safe, cost-efficient strategy to improve the appropriateness of postoperative ICU utilization.