Authors (including presenting author) :
Cheung YS (1), Chung WY (1), Tong KY (1), Wong ESL(1), Lai PBS (1)
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital
Introduction :
Patient admission on the day of surgical intervention is a safe and cost-effective strategy in well-selected patients. This practice is accepted by patients and allows better utilization of surgical beds for emergency admission. Same day admission practice has been introduced to patients undergoing transarterial chemoembolization (TACE) in our unit since 2016. The adoption of this practice has been slow with only 11% TACE being admitted on the day of procedure in 2017.
Objectives :
To improve same day admission rate for TACE in the Department of Surgery to 40% by the end of 2018 with the use of nurse-led admission program.
Methodology :
We performed a review of the TACE practice with the plan-do-study-act method. The logistics of arranging TACE and same day admission guideline were revised in February 2018. Nurse-led admission program with the support of specialty nurse clinic was introduced. Admission and outcome data were provided to surgeons on regular basis to monitor and evaluate same day admission practice.
Result & Outcome :
83 patients were admitted to our unit with 135 TACE episodes in 2018. 60 TACE episodes received same day admission. The same day admission rate was significantly increased from 14.3 % to 50% (p-value = 0.002) after the introduction of this program in February 2018. The monthly same day admission rates ranged from 36.4% to 72.7%. The most common reasons that required conventional admission practice the day before TACE were performance of TACE under research protocol (n=19) and unavailability of nurse clinic within 1 week before TACE (n=16). Same day admission was associated with a significant shorter median hospital stay (p-value = 0.005) of 3 days (range = 1 to 23 days) as compared to conventional admission practice of 4 days (range = 2 to 32 days). We encountered no practical problem or TACE cancellation with same day admission. There was no significant difference in emergency readmission rate (p-value = 0.298) between same day admission (3.3%) and convention admission practice (9.3%). In conclusion, use of nurse-led admission program was able to enhance same day admission practice for TACE and in-patient bed-day saved without jeopardizing procedure safety and patient flow.
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