Promoting Same-Day Discharge for Gynecologic Oncology Patients in Minimally Invasive Hysterectomy.
STUDY OBJECTIVE:Despite clear data demonstrating feasibility, safety, and cost-effectiveness of same-day discharge after minimally invasive hysterectomy, a paucity of data suggests ways to increase same-day discharge rates. Our objectives were to promote same-day discharge after minimally invasive hysterectomy using preoperative patient education videos, provider same-day discharge awareness initiatives, and standardization of postoperative management and to investigate reasons for overnight admission after surgery (non-same-day discharge). DESIGN:A quality improvement project measured rates of same-day discharge, patient satisfaction, and readmission during the 5 months before and after video implementation. Readmission rates were calculated as a surrogate for safety. A retrospective chart review was conducted of patients who underwent minimally invasive hysterectomy during the 5 months after video implementation, comparing 43 same-day discharges to 26 non-same-day discharge patients who met criteria for same-day discharge. Differences between groups were analyzed using 2-tailed t tests or logistic regression (continuous variables) and Fisher's exact test or χ2 test (categorical variables). Next, providers were educated about same-day discharge, and initiatives were implemented to standardize postoperative care. Same-day discharge rates were then calculated to evaluate these additional interventions (Canadian Task Force classification II-2). SETTING:A gynecologic oncology division based at an academic institution and performing surgery at 2 hospitals. PATIENTS:All patients undergoing minimally invasive hysterectomy for both benign and malignant disease, using robot-assisted, straight laparoscopic, and radical hysterectomy procedures. INTERVENTIONS:Patient education video, provider education about same-day discharge, and initiatives to standardize postoperative care. MEASUREMENTS AND MAIN RESULTS:Overall, same-day discharge rates decreased from 47% to 35% and readmission rates from 1.7% to 0% after video implementation. Greater than 87% of both groups were very or somewhat satisfied with their care (p = .71). Excluding patients who did not qualify for same-day discharge, the prevideo implementation same-day discharge rate was 72% (n = 78) and the postvideo implementation same-day discharge rate was 62% (n = 69). Higher patient complexity (p = .003), later case end time (p = .001), longer operative time (p = .001), and robot-assisted cases (p = .002) significantly predicted non-same-day discharge. After implementing initiatives to increase provider same-day discharge awareness and to standardize postoperative management, in addition to video implementation, the same-day discharge rate increased to 86% (n = 51). CONCLUSION:Same-day discharge in a select population is safe and feasible, with at least similar patient satisfaction as non-same-day discharge patients. Shorter operative time, earlier case end time, lower patient complexity, and non-robot-assisted approach increase the likelihood of same-day discharge. Patient education videos alone did not increase same-day discharges but maintained acceptable readmission rates. Communication with providers regarding the same-day discharge initiative and standardization of postoperative management with preoperative video implementation may lead to increased same-day discharge rates.
Fountain, CR; Havrilesky, LJ
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