Juviler Peter, Wilson Nicole A, Livingston Michael H, Levatino Elizabeth, Bowden Acacia, Meyers Jeffrey M, Tesini Brenda, Gleason Cassandra, Pegoli Walter, Arca Marjorie J, Wakeman Derek
Department of Surgery, University of Rochester Medical Center, Rochester, N.Y.
Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, N.Y.
Pediatr Qual Saf. 2023 Jan 16;8(1):e629. doi: 10.1097/pq9.0000000000000629. eCollection 2023 Jan-Feb.
Same-day discharge of children after appendectomy for simple appendicitis is safe and associated with enhanced parent satisfaction. Our general pediatric surgeons aimed to improve the rate of same-day discharge after appendectomy for simple appendicitis.
We implemented a clinical practice guideline in September 2019. A surgeon-of-the-week service model and the urgent operating room started in November 2019 and January 2020, respectively. Data for children with simple appendicitis from our academic medical center were gathered prospectively using National Surgical Quality Improvement Program-Pediatric. Patient outcomes before intervention implementation (n = 278) were compared with patients following implementation (n = 264).
The average monthly percentage of patients discharged on the day of surgery increased in the postimplementation group (32% versus 75%). Median postoperative length of stay decreased [16.5 hours (interquartile range, 15.9) versus 4.4 hours (interquartile range, 11.7), < 0.001], and the proportion of patients discharged directly from the postoperative anesthesia care unit increased (22.8% versus 43.6%; < 0.001). There were no differences in balancing measures, including the return to the emergency department and readmission. Fewer children were discharged home on oral antibiotics after implementation (6.8% versus 1.5%, = 0.002), and opioid prescribing at discharge remained low (2.5% versus 1.1%, = 0.385).
Using quality improvement methodology and care standardization, we significantly improved the rate of same-day discharge after appendectomy for simple appendicitis without impacting emergency department visits or readmissions. As a result, our health care system saved 140 hospital days over the first 21 months.
对于单纯性阑尾炎患儿，阑尾切除术后当日出院是安全的，且能提高家长满意度。我们的普通儿科外科医生旨在提高单纯性阑尾炎阑尾切除术后当日出院率。
我们于2019年9月实施了一项临床实践指南。每周指定一名外科医生的服务模式和急诊手术室分别于2019年11月和2020年1月启用。我们的学术医疗中心前瞻性收集了使用国家外科质量改进计划 - 儿科的数据，以研究单纯性阑尾炎患儿的情况。将干预实施前的患者数据（n = 278）与实施后的患者数据（n = 264）进行比较。
实施后组手术当日出院患者的月平均百分比有所增加（32% 对 75%）。术后住院时间中位数缩短[16.5小时（四分位间距，15.9）对4.4小时（四分位间距，11.7），P < 0.001]，且术后麻醉恢复室直接出院的患者比例增加（22.8% 对 43.6%；P < 0.001）。在平衡指标方面没有差异，包括返回急诊科和再次入院情况。实施后出院回家口服抗生素的儿童减少（6.8% 对 1.5%，P = 0.002），出院时开具阿片类药物的情况仍然较少（2.5% 对 1.1%，P = 0.385）。
通过质量改进方法和护理标准化，我们显著提高了单纯性阑尾炎阑尾切除术后当日出院率，且未影响急诊科就诊或再次入院情况。结果，我们的医疗保健系统在最初的21个月内节省了140个住院日。
