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Published on: January 7, 2019
Reducing Post-Operative Hospital Length of Stay following Uncomplicated Appendectomy in Pediatric Patients: A
Michelle A Jeski1,2, Jennifer D Stanger3, Melissa S Schafer4
1Department of Nursing, Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY 13210, USA.
Insights
Clinical pathways significantly reduced pediatric appendectomy length of stay from 2.5 to 0.5 days. This approach safely minimizes hospital time for children undergoing uncomplicated appendectomies.
Area of Science:
- Pediatric Surgery
- Hospital Administration
- Clinical Pathway Development
Background:
- Uncomplicated appendectomies are common pediatric surgical procedures.
- A mean post-operative length of stay (LOS) of 2.5 days was identified as excessive.
- Reducing LOS is beneficial for hospitals, patients, and families.
Purpose of the Study:
- To develop and evaluate clinical pathways to safely reduce the post-operative LOS for pediatric uncomplicated appendectomies.
- To decrease the mean LOS to 2.0 days or fewer.
Main Methods:
- Implementation of clinical pathways in an urban academic children's hospital.
- Emphasis on oral, non-narcotic pain management and caregiver education.
- Avoidance of routine post-operative antibiotic use.
- Evaluation in a convenience sample of 46 pediatric patients (ages 3-16).
Main Results:
- Successfully reduced the mean post-operative LOS by 80%, from 2.5 days to 0.5 days.
- Achieved this reduction without significant complications related to early discharge.
- Demonstrated the safety and efficacy of the intervention.
Conclusions:
- Carefully devised and disseminated clinical pathways can effectively and safely reduce hospital LOS after pediatric uncomplicated appendectomies.
- Optimized clinical pathways offer a viable strategy for improving resource utilization and patient throughput.
Abstract:
An uncomplicated appendectomy in children is common. Safely minimizing the post-operative length of stay is desirable from hospital, patient, and parent perspectives. In response to an overly long mean length of stay following uncomplicated appendectomies in children of 2.5 days, we developed clinical pathways with the goal of safely reducing this time to 2.0 or fewer days. The project was conducted in an urban, academic children's hospital. The pathways emphasized the use of oral, non-narcotic pain medications; the education of parents and caregivers about expectations regarding pain control, oral food intake, and mobility; and the avoidance of routine post-operative antibiotic use. A convenience sample of 46 patients aged 3-16 years old was included to evaluate the safety and efficacy of the intervention. The mean post-operative length of stay was successfully reduced by 80% to 0.5 days without appreciable complications associated with earlier discharge. The hospital length of stay following an uncomplicated appendectomy in children may be successfully and safely reduced through the use of carefully devised, well-defined, well-disseminated clinical pathways.
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