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Clinical Effectiveness Strategies to Improve Patient Outcomes After Pectus Excavatum Repair

Marisa E Schwab, Sarah Cohen, Hannah K Bassett

    Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality
    |December 8, 2025
    PubMed

    Insights

    Target-based care (TBC) improved patient outcomes after pectus excavatum repair. This strategy, combining TBC with a clinical pathway, significantly reduced length of stay and time to catheter and pain management discontinuation.

    Area of Science:

    • Pediatric surgery
    • Clinical effectiveness strategies
    • Healthcare quality improvement

    Background:

    • Target-based care (TBC) utilizes institutional data to establish a shared mental model for postoperative milestones.
    • This study assessed a clinical effectiveness strategy integrating TBC, a clinical pathway, and decision support for pectus excavatum repair outcomes.

    Purpose of the Study:

    • To evaluate the impact of a combined Target-based care and clinical pathway strategy on patient outcomes following pectus excavatum repair.
    • To determine if this integrated approach improves key process and outcome metrics.

    Main Methods:

    • A prospective study conducted at a quaternary children's hospital (2022-2024) with historical controls (2018-2021).
    • Target-based care involved bedside targets for length of stay (LOS), Foley catheter, and patient-controlled analgesia (PCA) discontinuation.
    • An evidence-based, multidisciplinary clinical pathway with an electronic order set was implemented.

    Main Results:

    • Median LOS decreased from 3 to 1.8 days (p < .05), with the proportion meeting the 2-day target increasing from 44.2% to 91.8% (p < .05).
    • Mean time to PCA discontinuation reduced from 1.6 to 0.8 days (p < .05).
    • Time to Foley catheter removal decreased from 22.2 to 17.1 hours (p < .05).

    Conclusions:

    • A data-driven Target-based care approach, coupled with a clinical pathway, demonstrated immediate and sustained positive effects on patient care.
    • The intervention led to significant reductions in length of stay, PCA discontinuation time, and Foley catheter removal time.
    Abstract

    Keywords:
    ERASopioidspathwayspectustarget-based care

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