单纯性急性阑尾炎的快速出院：在保持质量的同时缩短住院时间。
Expedited discharge in uncomplicated acute appendicitis: Decreasing the length of stay while maintaining quality.
机构信息
Cumming School of Medicine, University of Calgary, Department of Surgery, North Tower, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada.
Cumming School of Medicine, University of Calgary, Department of Surgery, North Tower, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada.
出版信息
Am J Surg. 2019 May;217(5):830-833. doi: 10.1016/j.amjsurg.2019.03.007. Epub 2019 Mar 13.
BACKGROUND
An expedited discharge protocol for uncomplicated appendicitis was developed at a Canadian academic hospital to determine if patients could be safely discharged home early without negatively impacting care and patient satisfaction.
METHODS
A non-randomized prospective quality improvement project was completed between February 01, 2017 and January 31, 2018. The project included patients between 16 and 65 years with uncomplicated appendicitis managed with laparoscopic appendectomy. The primary outcome was average length of stay post PACU. 30 day ED visit, cross-sectional imaging and readmission rate were balancing measures. The CTM-3 tool was used to measure patient satisfaction.
RESULTS
450 patients had emergent laparoscopic appendectomy. 287 (63.8%) patients met the project inclusion criteria. The average length of stay decreased 41.0% to 13.1 h. The 30 day ED visit, cross-sectional imaging and readmission rate were 9.8%, 4.5% and 1.0% respectively compared with 8.1%, 4.5% and 2.5% at baseline. Patient satisfaction was 3.72/4 compared to 3.74/4.
CONCLUSION
An expedited discharge after an uncomplicated laparoscopic appendectomy is safe and feasible without a negative impact on 30-day ED visit, diagnostic imaging or readmission.
背景
加拿大一家学术医院制定了一种用于治疗单纯性阑尾炎的快速出院方案，以确定患者是否可以安全地提前出院回家，而不会对护理和患者满意度产生负面影响。
方法
一项非随机前瞻性质量改进项目于 2017 年 2 月 1 日至 2018 年 1 月 31 日进行。该项目纳入了年龄在 16 至 65 岁之间、接受腹腔镜阑尾切除术治疗的单纯性阑尾炎患者。主要结局是 PACU 后平均住院时间。30 天 ED 就诊、横断面成像和再入院率是平衡措施。使用 CTM-3 工具来衡量患者满意度。
结果
450 例患者行急诊腹腔镜阑尾切除术。287 例（63.8%）患者符合项目纳入标准。平均住院时间缩短了 41.0%，至 13.1 小时。30 天 ED 就诊、横断面成像和再入院率分别为 9.8%、4.5%和 1.0%，而基线时分别为 8.1%、4.5%和 2.5%。患者满意度为 3.72/4，与 3.74/4 相比无差异。
结论
对于单纯性腹腔镜阑尾切除术患者，在不影响 30 天 ED 就诊、诊断性影像学检查或再入院率的情况下，快速出院是安全可行的。
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