Implementation of a "Same Night" Appendectomy (SNAppy) Discharge Protocol: A Quality Improvement Initiative

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Quality Improvement

Background:

• Appendectomy is a curative procedure for appendicitis.
• Prolonged hospitalization for uncomplicated appendicitis is often unnecessary.
• There is a need for efficient discharge protocols post-appendectomy.

Purpose of the Study:

• To implement and evaluate a protocol to expedite patient discharge post-appendectomy.
• To reduce length of stay (LOS) for pediatric appendectomy patients.
• To assess the impact on emergency department (ED) returns and inpatient bed utilization.

Main Methods:

• Utilized multiple plan-do-study-act (PDSA) cycles to develop and refine the discharge protocol.
• Implemented pre-operative, intra-operative, and post-operative care modifications.
• Measured post-operative LOS, ED returns, and inpatient bed utilization.
• Employed statistical process control charts and Mann Whitney U test for analysis.

Main Results:

• A total of 332 patients were analyzed (147 pre-protocol, 185 post-protocol).
• Median post-operative LOS decreased significantly from 11.2 hours to 1.5 hours (P < 0.00001).
• No significant difference in ED returns (6.8% pre-protocol vs. 9.2% post-protocol, P = 0.65).
• 68% of patients were discharged directly from the operating room post-protocol implementation compared to 0% pre-protocol.

Conclusions:

• The SNAppy protocol significantly reduced post-operative length of stay.
• Inpatient bed utilization was decreased without an increase in emergency department returns.
• The protocol effectively streamlines care for pediatric patients undergoing appendectomy.