Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative
| Autor: | Alison Laws, May Lynn Quan, Lynn Headley, Adam Elwi, Alysha Crocker, Angela Estey, Shannon Parker, Alysha R. Keehn, Susan Anderes, Joseph C Dort, David W. Olson |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Reoperation medicine.medical_specialty Quality management Adolescent medicine.medical_treatment MEDLINE Breast Neoplasms Audit Perioperative Care Young Adult 03 medical and health sciences Patient safety Postoperative Complications 0302 clinical medicine Humans Medicine Young adult Mastectomy Aged Aged 80 and over business.industry Perioperative Emergency department Middle Aged Quality Improvement Patient Discharge Surgery Treatment Outcome Ambulatory Surgical Procedures Oncology 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Patient Safety business Follow-Up Studies |
| Zdroj: | Annals of Surgical Oncology. 26:3354-3360 |
| ISSN: | 1534-4681 1068-9265 |
| DOI: | 10.1245/s10434-019-07568-5 |
| Popis: | Same-day surgery (SDS) following mastectomy is safe and well accepted. Overnight admission in patients fit for discharge is an inefficient use of health resources. In response to a national review highlighting SDS following mastectomy at 1.4% in Alberta, a perioperative pathway was conceived. The pathway was implemented across Alberta at 13 hospitals beginning in 2016. A steering committee was assembled, and clinical and administrative leads at each site were identified. Opportunities along the patient care experience whereby action could be taken to promote uptake of SDS were identified. Provincially branded support materials including presentations, order sets, and standard operating procedures were developed. Nurse educators provided in-service teaching such as standardized drain care and discharge teaching. Educational booklets, group classes, and online resources were developed for patients and families. An audit of SDS rates, unscheduled return to the emergency department (ED), and readmission rates was reported to teams quarterly, allowing for iterative modifications. Patient-reported experience measures (PREMs) were collected. SDS following mastectomy increased from 1.7 to 47.8%, releasing an estimated 831 bed days per year. No differences in unexpected return to the ED or readmission to hospital existed between SDS patients and those admitted overnight. A total of 102 patients completed the PREM survey, of whom 90% felt “excellent or good” with the plan to go home, how to care for themselves once home, and who to contact should issues arise. Implementation of a provincial perioperative pathway improved uptake of SDS following mastectomy and demonstrated favorable PREMs. |
| Databáze: | OpenAIRE |
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