Reducing length of stay in patients following liver transplantation using the model for continuous improvement.

Autor:	Sachar Y; Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada ysachar2023@meds.uwo.ca., Alamr A; Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada., Gob A; Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada.; Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada., Tang E; Department of General Surgery, Western University, London, Southeastern Ontario, Canada., Teriaky A; Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada., Qumosani K; Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada., Weernink C; Department of General Surgery, Western University, London, Southeastern Ontario, Canada., Dodds M; Department of General Surgery, Western University, London, Southeastern Ontario, Canada., Thomas K; Department of General Surgery, Western University, London, Southeastern Ontario, Canada., Sinclair L; Department of General Surgery, Western University, London, Southeastern Ontario, Canada., Skaro A; Department of General Surgery, Western University, London, Southeastern Ontario, Canada., Brahmania M; Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.; Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2023 Mar; Vol. 12 (1).
DOI:	10.1136/bmjoq-2022-002149
Abstrakt:	Length of stay (LOS) is a significant contributor to overall patient outcomes for patients undergoing liver transplantation. This study documents a quality improvement project aiming to reduce the median post-transplant LOS for liver transplant patients. We instituted five Plan-Do-Study-Act cycles with the goal of reducing LOS by 3 days from a baseline median of 18.4 days over 1 year. Balancing measures such as readmission rates ensured any decrease in stay was not associated with significantly increased patient complications. Over the 28-month intervention period and 24-month follow-up period, there were 193 patients discharged from hospital with a median LOS of 9 days. The changes appreciated during quality improvement interventions carried over to sustained improvements, with no significant variability in LOS postintervention. Discharge within 10 days increased from 18.4% to 60% over the study period, with intensive care unit stay decreasing from a median of 3.4-1.9 days. Thus, the development of a multidisciplinary care pathway, with patient engagement, led to improved and sustained discharge rates with no significant differences in readmission rates. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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