Combined use of advanced practice providers and care pathways reduces the duration of stay after surgery for gastrointestinal malignancies
Combined use of advanced practice providers and care pathways reduces the duration of stay after surgery for gastrointestinal malignancies
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DOI：
10.1016/j.surg.2020.06.015
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发表时间：
2021-03-20
期刊：
影响因子：
3.8
通讯作者：
Pimiento, Jose M.
中科院分区：
文献类型：
--
作者：
Broman, Kristy K.;Baez, Hansel;Pimiento, Jose M.
背景资料：在我们的综合癌症中心的胃肠外科肿瘤服务，旨在提高术后住院病人的护理质量，同时提高出院efficiency.Methods：利益相关者团队建立标准的术后护理路径和专门的住院先进的实践提供者的立场。我们使用Wilcoxon秩和检验比较了干预前（2017年7月至2018年4月）和干预后（2018年5月至2019年4月）的术后住院时间。我们以国家外科质量改进项目和医疗保险和医疗补助服务中心的几何平均住院时间作为基准。我们还比较了再入院率和外科医生特定的医院消费者对医疗保健提供者和系统的评估以及Press-Ganey评分。结果：干预前462例，干预后563例。干预后，中位住院时间从6.50天降至6.00天（P = .017）。机器人食管切除术（P = 0.001）、肝切除术（P = 0.023）和细胞减灭术联合热腹腔化疗（P = 0.030）的14种病例类型中有10种病例的住院时间减少>1天。干预后，更多的病例类型达到或超过了医疗保险和医疗补助服务中心以及国家手术质量改进项目的基准。再入院率稳定（干预前9.3%，干预后10.3%，P = 0.585）。Press-Ganey和HCAHPS指标在所有评价领域均稳定或改善。结论：将先进的实践提供者和护理途径纳入胃肠外科肿瘤住院护理与住院时间缩短相关，而再入院率或患者体验指标没有下降。(c)2020爱思唯尔公司All rights reserved.
Background: The gastrointestinal surgical oncology service at our comprehensive cancer center sought to improve the quality of postsurgical inpatient care while increasing discharge efficiency.Methods: A stakeholder team established standard postsurgical care pathways and dedicated inpatient advanced practice provider positions. We compared postsurgical length of stay before (July 2017 to April 2018) and after (May 2018 to April 2019) the interventions using Wilcoxon rank-sum tests. We bench marked length of stay to National Surgical Quality Improvement Project and Centers for Medicare and Medicaid Services geometric mean length of stay. We also compared readmission rates and surgeon specific Hospital Consumer Assessment of Health Care Provider and Systems and Press-Ganey scores. Results: There were 462 cases before and 563 after the interventions. Postintervention, median length of stay decreased from 6.50 to 6.00 days (P = .017). There was a >1-day reduction for 10 of 14 case types with significant length of stay decreases for robotic esophagectomy (P = .001), liver resection (P = .023), and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (P = .030). More case types met or exceeded Centers for Medicare and Medicaid Services and National Surgical Quality Improvement Project benchmarks after the interventions. Readmission rates were stable (preintervention 9.3%, postintervention 10.3%, P = .585). Press-Ganey and HCAHPS measures were stable or improved in all evaluated domains. Conclusion: Incorporating advanced practice providers and care pathways into gastrointestinal surgical oncology inpatient care was associated with reduced length of stay without declination in readmission rates or patient experience measures.(c) 2020 Elsevier Inc. All rights reserved.