Nurse-led Discharge for Gynecology Day Surgery to reduce Length of Stay

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Authors (including presenting author) :
Lo SL(1), Yu LME(2), Suen SM(1)
Affiliation :
(1)Integrated Care Centre, Princess Margaret Hospital, (2)Clinical Research Centre, Princess Margaret Hospital
Introduction :
Post-surgery doctor’s assessment was needed for discharge of gynecological patients with day surgery from Integrated Care Centre (ICC), Princess Margaret Hospital (PMH), but timely post-surgery doctor’s assessment was not always available; thus a well-structured nurse-led discharge (NLD) program was developed.
Objectives :
(1) To facilitate timely and effective discharge; (2) To improve quality of care.
Methodology :
This is a prospective cohort study of 211 female patients (median age 50 years) admitted to Integrated Care Centre (ICC) and transferred to Operation Theatre for gynecological surgery from April 2017 to October 2018, in which the NLD program was implemented starting from October 2017 replacing the routine discharge practice. Under the NLD program, patients were assessed by trained nurse with the use of ‘Nurse-led Discharge Criteria and Checklist for Day Surgery’ after transferring back to ICC. Patients would be discharged if the discharge criteria were met, otherwise they would be assessed by doctors and then transferred to gynecological ward if indicated. All patients transferred back to gynecological ward were excluded. The post-surgery length of stay (LOS) in ICC was recorded. Phone follow up for patients’ post-surgery condition and satisfaction was conducted by responsible nurse on the next working day. Satisfaction of eight nurses responsible for NLD program was also collected.
Result & Outcome :
There were 47 and 164 gynecologic patients admitted to ICC under the routine discharge practice and NLD program, respectively. The median post-surgery doctor’s assessment time for routine discharged patients was 5.7 (interquartile range [IQR], 4.4-7) hours, while no NLD patient required doctor’s assessment before discharge from ICC. Age, type and duration of surgery were comparable between two groups. The post-surgery ICC LOS was significantly shorter in the NLD group (median, 4.4 [IQR, 3.7-5.2] hours) than that in the routine discharge group (median, 5.9 [IQR, 5-7.2] hours) with p<0.001. The readmission rate within 2 weeks did not differ (NLD: 3% vs. routine discharge: 0%, p=0.589). There was no significant difference in patient satisfaction between groups. All nurses deemed that NLD program was good to both patients and staff. Conclusion:
The NLD program for gynecology day surgery was effective to reduce LOS and enhance quality of care, thereby save medical resources.

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