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A Fast-Track Pathway for Emergency General Surgery at an Academic Medical Center.

Amanda Fazzalari1, Shruthi Srinivas2, Suraj Panjwani1

  • 1Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut.

The Journal of Surgical Research
|June 11, 2021
PubMed
Summary

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Fast Track Pathways (FTP) significantly reduced length of stay and costs for emergency general surgery (EGS) patients. This study shows FTP implementation at an academic medical center improved efficiency without affecting patient satisfaction or reimbursement.

Area of Science:

  • Surgical Innovation
  • Healthcare Management
  • Patient Outcomes

Background:

  • Fast Track Pathways (FTP) are increasingly used to reduce length of stay (LOS) and costs in emergency surgeries.
  • Implementation of FTP for Emergency General Surgery (EGS) is being evaluated at academic medical centers (AMCs).

Purpose of the Study:

  • To evaluate the implementation of a Fast Track Pathway (FTP) for Emergency General Surgery (EGS) at an academic medical center (AMC).

Main Methods:

  • A study involving 165 patients undergoing laparoscopic appendectomy, cholecystectomy, or inguinal hernia repair between 2016-2018.
  • Comparison of 89 patients in the FTP group versus 76 controls, analyzing time to surgery (TTS), LOS, post-operative LOS, costs, reimbursements, and patient satisfaction.

Main Results:

Keywords:
Acute appendicitisAcute cholecystitisEmergency general surgeryFast track

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  • The FTP group had a significantly shorter LOS (15h17min vs. 29h09min) and post-operative LOS (3h11min vs. 20h10min).
  • FTP implementation led to significantly lower direct costs and reduced hospital bed/overnight stay utilization.
  • No significant impact on reimbursement or patient satisfaction (average 3.3/4) was observed.

Conclusions:

  • Fast Track Pathways (FTP) play a significant role in EGS by decreasing costs and optimizing resources.
  • An EGS FTP at an AMC significantly decreased LOS and hospital bed utilization.
  • FTP implementation did not negatively impact reimbursement or patient satisfaction.