Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.
BMJ Open Qual. 2023 Mar;12(1). doi: 10.1136/bmjoq-2022-002149.
Length of stay (LOS) is a significant contributor to overall patient outcomes for patients undergoing liver transplantation. This study documents a quality improvement project aiming to reduce the median post-transplant LOS for liver transplant patients. We instituted five Plan-Do-Study-Act cycles with the goal of reducing LOS by 3 days from a baseline median of 18.4 days over 1 year. Balancing measures such as readmission rates ensured any decrease in stay was not associated with significantly increased patient complications. Over the 28-month intervention period and 24-month follow-up period, there were 193 patients discharged from hospital with a median LOS of 9 days. The changes appreciated during quality improvement interventions carried over to sustained improvements, with no significant variability in LOS postintervention. Discharge within 10 days increased from 18.4% to 60% over the study period, with intensive care unit stay decreasing from a median of 3.4-1.9 days. Thus, the development of a multidisciplinary care pathway, with patient engagement, led to improved and sustained discharge rates with no significant differences in readmission rates.
住院时间（LOS）是肝移植患者整体治疗效果的重要影响因素。本研究记录了一项质量改进项目，旨在将肝移植患者的术后 LOS 中位数降低 3 天，从基线的 18.4 天降低 1 年。通过实施五个计划-执行-研究-行动循环，我们设定了目标，以确保在 LOS 减少的同时，患者并发症的发生率不会显著增加。在 28 个月的干预期和 24 个月的随访期内，共有 193 名患者出院，其 LOS 的中位数为 9 天。质量改进干预期间取得的变化得以持续改进，且 LOS 无显著变化。出院时间在 10 天内的患者比例从研究开始时的 18.4%增加到了 60%，重症监护病房的停留时间从中位数 3.4 天减少到了 1.9 天。因此，多学科护理路径的制定，加上患者的参与，提高了出院率并保持了稳定，同时再入院率没有显著差异。
