Challenge of balancing duration of stay and readmissions in children's operation

Short, Heather L.; Parakati, Isaac; Heiss, Kurt F.; Wulkan, Mark L.; Sweeney, John F.; Raval, Mehul V.

doi:10.1016/j.surg.2017.06.005

Cited by 8 publications

(2 citation statements)

References 17 publications

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“…However, an association was also found between laparoscopic surgery and more unplanned readmissions, which increased significantly across CHD severity groups (Table 5). This finding emphasizes the tension between LOS and readmissions as quality metrics seen in surgery [31] and impacts patient counseling. Second, laparoscopic surgery was associated with lower odds of blood transfusion within 72 hours of the procedure compared to open surgery for all children.…”

Section: Discussionmentioning

confidence: 89%

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease

Chu

Tan

Mattei

et al. 2018

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 89%

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease

Chu

Tan

Mattei

et al. 2018

Journal of Pediatric Surgery

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“…Unsurprisingly, the time of day patients were being discharged following postoperative overnight observation varied widely, with only 10.4% of patients discharged before 11 AM. Therefore, using studies in orthopedic surgery 19 and pediatric pulmonology 20 as a model and acknowledging the challenge of balancing efficiency and length of stay with hospital readmission rates, 21 we implemented a quality improvement (QI) project to improve the hospital discharge time for pediatric patients admitted following tonsillectomy. Our objective was to improve the tonsillectomy discharge process for families and providers by increasing the percentage of patients discharged before 11 AM on postoperative day 1 (POD1) to at least 50% within 1 year.…”

Section: Introductionmentioning

confidence: 99%

Improving the Pediatric Floor Discharge Process Following Tonsillectomy

et al. 2021

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Objectives/Hypothesis Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. Study Design Prospective observational (quality improvement). Methods A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was “timely discharges,” defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven‐day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record‐based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. Results Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7‐day readmission rates were unchanged. Conclusions By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. Level of Evidence 3 Laryngoscope, 132:225–233, 2022

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A Visual Decision Support Tool for Appendectomy Care

2018

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Appendectomy is the most common abdominal surgical procedure performed in children in the United States. In order to assist care providers in creating treatment plans for the postoperative management of pediatric appendicitis, we have developed a predictive statistical model of outcomes on which we have built a prototype decision aid application. The model, trained on 3724 anonymized care records and evaluated on a separate set of 2205 cases from a tertiary care center, achieves 97.0% specificity, 25.1% true sensitivity, and 58.8% precision. We have also built an interactive decision support tool augmented with simple visualization techniques designed for clinicians to use in the course of making care decisions (e.g., discharge) and in patient/stakeholder communication. Its focus is on end-user ease of use and integration into existing clinician workflows, and is designed to evolve its predictions as more and better data become available.

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Challenge of balancing duration of stay and readmissions in children's operation

Abstract: Our theoretical model aimed at balancing readmissions by extending duration of stay to capture early complications results in a substantial increase in hospital days illustrating the conflict between competing quality metrics and limited resources.

Cited by 8 publications

References 17 publications

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease

Improving the Pediatric Floor Discharge Process Following Tonsillectomy

A Visual Decision Support Tool for Appendectomy Care

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