Implementation of a small bowel obstruction guideline improves hospital efficiency
Wendy L Wahl1, Sandra L Wong, Christopher J Sonnenday
1Trauma and Surgical Critical Care, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI 48106-0995, USA. wahlwl@trinity-health.org
Surgery
|September 4, 2012
Summary
Implementing a small bowel obstruction (SBO) guideline improved patient triage and outcomes. The guideline reduced time to operation and hospital stay for SBO patients requiring surgery.
Area of Science:
- Surgical outcomes research
- Healthcare management and policy
Background:
- Small bowel obstruction (SBO) management involves complex triage decisions.
- Concerns about delayed surgical intervention prompted the development of a standardized SBO management guideline.
- A hypothesis was formulated that guideline implementation would enhance triage accuracy and patient outcomes.
Purpose of the Study:
- To evaluate the impact of a newly implemented institutional SBO management guideline.
- To assess changes in patient triage, time to intervention, and hospital duration of stay post-guideline implementation.
Main Methods:
- A multidisciplinary team developed an SBO service triage and initial management guideline, instituted in 2011.
- Administrative data from fiscal year 2010 (pre-guideline) were compared with the first six months of 2011 (post-guideline).
- Key metrics analyzed included time to computed tomography scan, operating room, general surgery consultation, and hospital length of stay, comparing medicine and general surgery admissions before and after the guideline.
Main Results:
- Following guideline implementation, the proportion of SBO patients admitted to general surgery increased from 55% to 66%.
- Time to general surgery consultation significantly decreased (P < .001).
- Time from admission to operation was reduced from 0.9 to 0.4 days (P < .05), and mean hospital stay decreased by 2 days (P < .001).
Conclusions:
- A hospital-wide SBO guideline effectively improved initial management and triage processes.
- Guideline implementation led to a significant reduction in time to operative intervention for SBO patients.
- The study demonstrated a shortened hospital duration of stay for patients requiring surgical treatment for SBO.
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