Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
Laryngoscope. 2021 Nov;131(11):2610-2615. doi: 10.1002/lary.29577. Epub 2021 May 12.
Standardization of postoperative care using clinical care guidelines (CCG) improves quality by minimizing unwarranted variation. It is unknown whether CCGs impact patient throughput in outpatient adenotonsillectomy (T&A). We hypothesize that CCG implementation is associated with decreased postoperative length of stay (LOS) in outpatient T&A.
A multidisciplinary team was assembled to design and implement a T&A CCG. Standardized discharge criteria were established, including goal fluid intake and parental demonstration of medication administration. An order set was created that included a hard stop for discharge timeframe with choices "meets criteria," "4-hour observation," and "overnight stay." Consensus was achieved in June 2018, and the CCG was implemented in October 2018. Postoperative LOS for patients discharged the same day was tracked using control chart analysis with standard definitions for centerline shift being utilized. Trends in discharge timeframe selection were also followed.
Between July 2015 and August 2017, the average LOS was 4.82 hours. This decreased to 4.39 hours in September 2017 despite no known interventions and remained stable for 17 months. After CCG implementation, an initial trend toward increased LOS was followed by centerline shifts to 3.83 and 3.53 hours in March and October 2019, respectively. Selection of the "meets criteria" discharge timeframe increased over time after CCG implementation (R = 0.38 P = .003).
Implementation of a CCG with standardized discharge criteria was associated with shortened postoperative LOS in outpatient T&A. Concurrently, surgeons shifted practice to discharge patients upon meeting criteria rather than after a designated timeframe.
NA Laryngoscope, 131:2610-2615, 2021.
通过使用临床护理指南（CCG）来标准化术后护理，可以通过最小化不必要的差异来提高护理质量。目前尚不清楚 CCG 是否会影响门诊腺样体切除术（T&A）患者的周转。我们假设 CCG 的实施与门诊 T&A 术后住院时间（LOS）的缩短有关。
成立了一个多学科团队来设计和实施 T&A CCG。制定了标准化的出院标准，包括目标液体摄入量和父母对药物管理的演示。创建了一个医嘱集，其中包括一个出院时间的硬截止，有“符合标准”、“4 小时观察”和“过夜”三种选择。共识于 2018 年 6 月达成，CCG 于 2018 年 10 月实施。使用控制图分析跟踪同一天出院患者的术后 LOS，使用中心线偏移的标准定义。还跟踪了出院时间选择的趋势。
2015 年 7 月至 2017 年 8 月，平均 LOS 为 4.82 小时。尽管没有已知的干预措施，但在 2017 年 9 月下降至 4.39 小时，并保持稳定 17 个月。在 CCG 实施后，首先出现了 LOS 增加的趋势，随后在 2019 年 3 月和 10 月，中心线分别转移至 3.83 和 3.53 小时。CCG 实施后，选择“符合标准”出院时间的比例逐渐增加（R=0.38，P=0.003）。
实施具有标准化出院标准的 CCG 与门诊 T&A 术后 LOS 缩短有关。同时，外科医生改变了实践方式，在符合标准后而不是在指定时间后为患者出院。
无 Laryngoscope, 131:2610-2615, 2021.
