Clinical Effectiveness Strategies to Improve Patient Outcomes After Pectus Excavatum Repair
Summary
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.
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