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EPV258/#285 Improving the rates of same day discharge in robotic surgery patients – a gynecologic oncology quality improvement project
  1. J Mateshaytis1,
  2. S Pin2,
  3. H Steed2 and
  4. M Brawner2
  1. 1University of Calgary, Gynecologic Oncology, Calgary, Canada
  2. 2University of Alberta, Gynecologic Oncology, Edmonton, Canada


Objectives In appropriately selected gynecologic oncology (GO) patients, robotic or laparoscopic surgery is a preferred approach (faster recovery, fewer complications, shorter hospital stay). Furthermore, same day discharge (SDD) is safe and effective in these patients. Evidence suggests no increased rates of readmission, or complications for SDD compared with overnight observation. We pursued a Quality Improvement (QI) project aimed at increasing our rate of SDD by 50% by June 2021 in GO robotic surgery patients.

Methods This QI initiative is based upon the Institute for Healthcare Improvement’s Model for Improvement. The study is an interrupted time series study. Baseline data assessment determined the rate of SDD and potential root causes for failed SDD. For each intervention (addressing a root cause), Plan-Do-Study-Act cycles were conducted. Outcome, process, and balancing measures were collected prospectively.

Results Four simple interventions were selected for implementation: 1) setting SDD as the default discharge plan, 2) providing a physician discharge order on the patient chart, 3) removing the foley catheter in the OR, 4) developing comprehensive standardized perioperative patient education materials. The rate of SDD was improved from 28.8% (baseline) to 69.4% following the changes. There was no increased 30-day rate of readmission (0% SDD vs 1.3% all robotic cases) or presentation to the emergency department (1.9% SDD vs 3.8% all robotic cases) following implementation of the interventions.

Conclusions Local rates of SDD can be improved with simple interventions targeting disposition planning, foley catheter removal and managing patient expectations. These interventions may be easily applicable to other GO programs.

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