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Post operative pediatric appendicitis nurse-driven discharge: Patient outcomes and nursing perspectives
Michael Chisum1, Amber May2, Mansen Wang3
1Swedish Medical Center, First Hill Campus, General Surgery Residency, 747 Broadway - Surgery Residency Program, Ste WW 739, Seattle, WA, 98122, USA.
Background:
Nurse-driven discharge pathways following pediatric appendectomies have proven effective in children's hospitals; studies in general hospital settings are lacking. Additionally, despite the central role of nursing in such pathways, nursing perspectives aren't investigated in the literature.
Methods:
Data from all pediatric acute uncomplicated appendicitis patients who underwent laparoscopic appendectomy in the 12 months following institution of a nurse-driven discharge pathway (intervention, n = 67) were compared to those treated in the preceding year (control, n = 64). Surveys on the pathway were distributed to pediatric ward nurses.
Results:
Postoperative length of stay (POLOS) decreased by 37% in the intervention group, about 6 h, (0.44 days ± 0.22 vs 0.7 days ± 0.27, p-value 0.0001), without a significant increase in related readmissions. Same day discharges increased from 10.9% to 46.3%, (P-value 0.0001). Nurse surveys revealed a high approval of the pathway (7-10/10) and yielded valuable feedback.
Conclusion:
A nurse-driven discharge pathway decreased POLOS without increasing readmission following pediatric laparoscopic appendectomy in a general hospital setting. Valuable insight into nursing perspectives on this pathway was acquired.
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