Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Department of Otolaryngology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
BMJ Open Qual. 2023 Mar;12(1). doi: 10.1136/bmjoq-2022-002123.
Healthcare systems face unprecedented numbers of patients waiting for elective treatments in the wake of the COVID-19 pandemic. Hospitals must urgently optimise patient pathways and build capacity to meet the populations health needs. Criteria-led discharge (CLD) is frequently used to optimise elective care pathways but may hold potential in discharging patients at the end of an acute hospital admission.
We conducted a quality improvement project to design and introduce a novel inpatient pathway using CLD for patients with severe acute tonsillitis. Our analysis compared the standardisation of treatment, length of stay, discharge time and readmission rate between those treated on the novel pathway compared with standard treatment.
The study population included 137 patients admitted to a tertiary centre with acute tonsillitis. Introduction of the tonsillitis pathway using CLD resulted in a significant reduction in median length of stay from 24 hours to 18 hours. Of those treated on the tonsillitis pathway, 52.2% were discharged prior to midday compared with 29.1% who received standard treatment. No patient discharged using CLD required readmission.
CLD is safe and effective at reducing length of stay in patients requiring acute hospital admission for acute tonsillitis. CLD should be used and evaluated in further novel patient pathways across different areas of medicine to optimise care and build capacity for provision of elective healthcare services. Further research is required to investigate safe and optimal criteria which indicate patients are fit for discharge.
在 COVID-19 大流行之后，医疗保健系统面临着前所未有的大量等待 elective 治疗的患者。医院必须紧急优化患者路径并建立能力，以满足人群的健康需求。基于标准的出院（CLD）常用于优化 elective 护理路径，但在急性住院患者出院时也可能具有潜力。
我们开展了一项质量改进项目，为患有严重急性扁桃体炎的患者设计并引入了一种使用 CLD 的新型住院途径。我们的分析比较了在新型途径和标准治疗下治疗的患者的治疗标准化程度、住院时间、出院时间和再入院率。
研究人群包括 137 名因急性扁桃体炎入住三级中心的患者。使用 CLD 引入扁桃体炎途径后，住院时间中位数从 24 小时显著缩短至 18 小时。在接受扁桃体炎途径治疗的患者中，52.2%的患者在中午前出院，而接受标准治疗的患者为 29.1%。使用 CLD 出院的患者无一例需要再次入院。
CLD 可安全有效地缩短因急性扁桃体炎而需要急性住院的患者的住院时间。CLD 应在不同医学领域的其他新型患者路径中使用和评估，以优化护理并建立提供 elective 医疗服务的能力。需要进一步研究来调查表明患者适合出院的安全和最佳标准。
