Scholars@Duke publication: Better at home: A quality improvement initiative to increase same day discharge after minimally invasive hysterectomies in gynecologic oncology.

Better at home: A quality improvement initiative to increase same day discharge after minimally invasive hysterectomies in gynecologic oncology.

Journal articles - Journal Article

Peters, PN; Morello, M; Tyler-Walker, J; Sterrett, E; McLean, H; Havrilesky, LJ

Published in: Gynecol Oncol Rep

August 2026

OBJECTIVE: To increase the rate of same-day discharge after minimally invasive hysterectomy. METHODS: A quality improvement initiative was implemented at a large academic medical center for patients undergoing minimally invasive hysterectomy by a gynecologic oncologist. The Institute for Healthcare Improvement (IHI) Model for Improvement framework was utilized to define the primary aim, develop interventions, and designate tracked measures. The primary aim was to increase the rate of same-day discharge after minimally invasive hysterectomy from a 61% baseline rate to over 90% within 8 months. Process measures included improving the percentage of cases scheduled as ambulatory surgeries. Balancing measures included emergency department encounters and time spent in the post-anesthesia care unit (PACU). Statistical process control charts were used to track measures. Our main interventions were: 1) creation of standard work (elimination of void trials, standard language in pre-operative surgical consent); 2) patient education initiative; 3) case discussions at division meetings to promote evidence-based care. RESULTS: The rate of same-day discharge improved significantly from 61% to 85% over a 1-year period. The percentage of minimally invasive hysterectomy cases scheduled as ambulatory surgery improved from 3.5% to 81%. There was no change in the mean time spent in the PACU or in emergency department encounters within 1 week after surgery. CONCLUSIONS: A quality improvement initiative with simple interventions focused the creation of standard work, patient education, and provider culture significantly improved rates of same day discharge after minimally invasive hysterectomy without increasing post-op emergency room visits or time in the PACU.