Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia.
Department of Nursing, Monash Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2022 Jul;58(7):1238-1243. doi: 10.1111/jpc.15966. Epub 2022 Apr 9.
Criteria-led discharge (CLD) protocols have been suggested to increase efficiency of discharge from hospital following surgical interventions. Our aim was to assess the feasibility, clinical outcomes and parental satisfaction following the introduction of a pilot CLD for simple appendicitis (SA) in children.
A prospective pilot cohort study was conducted including paediatric patients with SA who were managed with CLD and a control group who were managed with standard discharge procedures. A CLD pro forma was developed, standardising care guidelines and clinical criteria indicators to be met for children to be discharged post-operatively. A post-discharge parent survey was also utilised. The primary outcome measure was post-operative length of stay (pLOS), with secondary outcomes of post-operative complication rates and parental satisfaction.
The control group consisted of 31 patients and CLD group 35 patients. There was no difference in the median pLOS (24 [16.7-44.6] vs. 25.3 [19.1-50.1] h, P = 0.3). Furthermore, there were no significant differences on any of the secondary outcomes. Parental confidence with time of discharge was very high in both control (85.7%) and CLD (88.2%) groups (P = 1.0).
The introduction of CLD is safe and feasible. Whilst this pilot has not demonstrated a reduction in pLOS, our data suggest that it is well accepted by the parents.
有研究提出以标准引导患者出院（CLD）的方案，以提高手术后患者从医院出院的效率。我们旨在评估在小儿单纯阑尾炎（SA）中引入 CLD 方案的可行性、临床结局和患儿父母的满意度。
本研究为前瞻性试点队列研究，纳入了接受 CLD 方案治疗的小儿单纯阑尾炎患者（CLD 组）和接受标准出院程序治疗的对照组。制定了 CLD 方案表单，以标准化护理指南和临床标准指标，以满足患儿术后出院的条件。还利用了出院后父母的调查。主要结局测量指标为术后住院时间（pLOS），次要结局测量指标为术后并发症发生率和父母满意度。
对照组有 31 例患者，CLD 组有 35 例患者。两组的 pLOS 中位数无差异（24 [16.7-44.6] vs. 25.3 [19.1-50.1] h，P=0.3）。此外，任何次要结局均无显著差异。对照组和 CLD 组的父母对出院时间的信心都非常高（分别为 85.7%和 88.2%，P=1.0）。
CLD 的引入是安全可行的。虽然本试点研究并未显示 pLOS 缩短，但我们的数据表明，它得到了父母的广泛认可。
