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Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients

OBJECTIVE: To determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer. METHODS: Study design was a r...

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Autores principales: O’Connell, Daniel A., Barber, Brittany, Klein, Max F., Soparlo, Jeff, Al-Marzouki, Hani, Harris, Jeffrey R., Seikaly, Hadi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631082/
https://www.ncbi.nlm.nih.gov/pubmed/26525293
http://dx.doi.org/10.1186/s40463-015-0090-6
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author O’Connell, Daniel A.
Barber, Brittany
Klein, Max F.
Soparlo, Jeff
Al-Marzouki, Hani
Harris, Jeffrey R.
Seikaly, Hadi
author_facet O’Connell, Daniel A.
Barber, Brittany
Klein, Max F.
Soparlo, Jeff
Al-Marzouki, Hani
Harris, Jeffrey R.
Seikaly, Hadi
author_sort O’Connell, Daniel A.
collection PubMed
description OBJECTIVE: To determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer. METHODS: Study design was a retrospective case-control study of patients undergoing major head and neck cancer resections and reconstruction at a tertiary referral centre. The intervention was rigid adherence to a pre-existing care pathway including flow algorithms and multidisciplinary checklists incorporated into patient charting and care orders. 157 patients were enrolled prospectively and were compared to 99 patients in a historical cohort. Patient charts were reviewed and information related to the patient, procedure, and post-operative course was extracted. The two groups were compared for number of major and minor complications (using the Clavien-Dindo system) and length of stay in hospital. RESULTS: Comparing pre- and post-intervention groups, no significant difference was identified in duration of hospital stay (21.5 days vs. 20.5 days, p = 0.750), the rate of major complications was significantly higher in the pre-intervention cohort (25.3 % vs. 14.0 %, p = 0.031), the rate of minor complications was not significantly higher (34.3 % vs 30.8 %, p = 0.610). CONCLUSION: Rigid adherence to our patient care pathway, and improved charting techniques including flow algorithms and multidisciplinary checklists has improved patient care by showing a significant reduction in the rate of major complications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40463-015-0090-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-46310822015-11-04 Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients O’Connell, Daniel A. Barber, Brittany Klein, Max F. Soparlo, Jeff Al-Marzouki, Hani Harris, Jeffrey R. Seikaly, Hadi J Otolaryngol Head Neck Surg Original Research Article OBJECTIVE: To determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer. METHODS: Study design was a retrospective case-control study of patients undergoing major head and neck cancer resections and reconstruction at a tertiary referral centre. The intervention was rigid adherence to a pre-existing care pathway including flow algorithms and multidisciplinary checklists incorporated into patient charting and care orders. 157 patients were enrolled prospectively and were compared to 99 patients in a historical cohort. Patient charts were reviewed and information related to the patient, procedure, and post-operative course was extracted. The two groups were compared for number of major and minor complications (using the Clavien-Dindo system) and length of stay in hospital. RESULTS: Comparing pre- and post-intervention groups, no significant difference was identified in duration of hospital stay (21.5 days vs. 20.5 days, p = 0.750), the rate of major complications was significantly higher in the pre-intervention cohort (25.3 % vs. 14.0 %, p = 0.031), the rate of minor complications was not significantly higher (34.3 % vs 30.8 %, p = 0.610). CONCLUSION: Rigid adherence to our patient care pathway, and improved charting techniques including flow algorithms and multidisciplinary checklists has improved patient care by showing a significant reduction in the rate of major complications. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40463-015-0090-6) contains supplementary material, which is available to authorized users. BioMed Central 2015-11-02 /pmc/articles/PMC4631082/ /pubmed/26525293 http://dx.doi.org/10.1186/s40463-015-0090-6 Text en © O’Connell et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research Article
O’Connell, Daniel A.
Barber, Brittany
Klein, Max F.
Soparlo, Jeff
Al-Marzouki, Hani
Harris, Jeffrey R.
Seikaly, Hadi
Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
title Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
title_full Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
title_fullStr Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
title_full_unstemmed Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
title_short Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
title_sort algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631082/
https://www.ncbi.nlm.nih.gov/pubmed/26525293
http://dx.doi.org/10.1186/s40463-015-0090-6
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