Fast-tracking: eliminating roadblocks to successful early discharge

With continually increasing health care costs and limited medical resources, there has been increasing focus on shortening hospital stays. Many medical and nonmedical reasons can lead to a delay in hospital discharge after thoracic surgery despite technically successful procedures; common obstacles include inadequate pain control, prolonged air leaks, and social issues. Preoperative patient education, minimally invasive surgical techniques, aggressive pain control, and early resumption of physical activity and discontinuation of chest tubes and catheters are important in successful early discharge. Although many of these components can be combined in clinical pathways to optimize care with the input of various members of the patient care team, the thoracic surgeon must reassess outcomes constantly to ensure the maintenance of the quality of care.