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Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients
Congenital heart disease (CHD), the most common congenital malformation, often requires surgical correction. As surgical mortality rates are low, a common quality marker linked with surgical outcomes is hospital length of stay (LOS). Reduced LOS is associated with better long-term outcomes, reduced...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678001/ https://www.ncbi.nlm.nih.gov/pubmed/34934877 http://dx.doi.org/10.1097/pq9.0000000000000493 |
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author | Cosgrove, Tara C. Carlozzi, Lauren N. Dolan, Kevin F. Gleeson, Sean P. Johnson, Lanette L. Cassidy, Steven C. Gajarski, Robert J. |
author_facet | Cosgrove, Tara C. Carlozzi, Lauren N. Dolan, Kevin F. Gleeson, Sean P. Johnson, Lanette L. Cassidy, Steven C. Gajarski, Robert J. |
author_sort | Cosgrove, Tara C. |
collection | PubMed |
description | Congenital heart disease (CHD), the most common congenital malformation, often requires surgical correction. As surgical mortality rates are low, a common quality marker linked with surgical outcomes is hospital length of stay (LOS). Reduced LOS is associated with better long-term outcomes, reduced hospital-acquired complications, and improved patient-family satisfaction. This project aimed to reduce aggregate median postoperative LOS for four CHD lesions from a baseline of 6.2 days by 10%. METHODS: This single-center study utilized the Institute for Healthcare Improvement model to achieve the project aim. A diuretic wean protocol implemented in April 2018 entailed weaning to a homegoing diuretic regimen upon transfer from the cardiac intensive care unit to the inpatient step-down unit. A discharge milestone checklist implemented in September 2018 contained milestones necessary for discharge and an anticipated date of discharge. Outcome measures included aggregate median postoperative LOS and ∆LOS. Balancing measures included cardiac intensive care unit bounce back, pleural chest tube replacement, and readmission rates. RESULTS: Our baseline aggregate median postoperative LOS for the lesions studied was 6.2 days. Following diuretic protocol implementation, the aggregate median LOS decreased to 4.4 days. Baseline ∆LOS decreased from 5.5 to 0.42 days. Postoperative cost fell by an average of $11,874. Balancing measures demonstrated no unintended consequences. CONCLUSIONS: Implementation of a diuretic wean protocol led to sustained improvement in postoperative LOS, and ∆LOS in a subset of CHD patients with no unintended consequences supporting that standardization of postoperative care is effective for improvement efforts and can reduce overall practice variation. |
format | Online Article Text |
id | pubmed-8678001 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-86780012021-12-20 Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients Cosgrove, Tara C. Carlozzi, Lauren N. Dolan, Kevin F. Gleeson, Sean P. Johnson, Lanette L. Cassidy, Steven C. Gajarski, Robert J. Pediatr Qual Saf Individual QI projects from single institutions Congenital heart disease (CHD), the most common congenital malformation, often requires surgical correction. As surgical mortality rates are low, a common quality marker linked with surgical outcomes is hospital length of stay (LOS). Reduced LOS is associated with better long-term outcomes, reduced hospital-acquired complications, and improved patient-family satisfaction. This project aimed to reduce aggregate median postoperative LOS for four CHD lesions from a baseline of 6.2 days by 10%. METHODS: This single-center study utilized the Institute for Healthcare Improvement model to achieve the project aim. A diuretic wean protocol implemented in April 2018 entailed weaning to a homegoing diuretic regimen upon transfer from the cardiac intensive care unit to the inpatient step-down unit. A discharge milestone checklist implemented in September 2018 contained milestones necessary for discharge and an anticipated date of discharge. Outcome measures included aggregate median postoperative LOS and ∆LOS. Balancing measures included cardiac intensive care unit bounce back, pleural chest tube replacement, and readmission rates. RESULTS: Our baseline aggregate median postoperative LOS for the lesions studied was 6.2 days. Following diuretic protocol implementation, the aggregate median LOS decreased to 4.4 days. Baseline ∆LOS decreased from 5.5 to 0.42 days. Postoperative cost fell by an average of $11,874. Balancing measures demonstrated no unintended consequences. CONCLUSIONS: Implementation of a diuretic wean protocol led to sustained improvement in postoperative LOS, and ∆LOS in a subset of CHD patients with no unintended consequences supporting that standardization of postoperative care is effective for improvement efforts and can reduce overall practice variation. Lippincott Williams & Wilkins 2021-12-15 /pmc/articles/PMC8678001/ /pubmed/34934877 http://dx.doi.org/10.1097/pq9.0000000000000493 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Individual QI projects from single institutions Cosgrove, Tara C. Carlozzi, Lauren N. Dolan, Kevin F. Gleeson, Sean P. Johnson, Lanette L. Cassidy, Steven C. Gajarski, Robert J. Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients |
title | Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients |
title_full | Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients |
title_fullStr | Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients |
title_full_unstemmed | Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients |
title_short | Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients |
title_sort | standardization of care reduces length of stay for postoperative congenital heart disease patients |
topic | Individual QI projects from single institutions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678001/ https://www.ncbi.nlm.nih.gov/pubmed/34934877 http://dx.doi.org/10.1097/pq9.0000000000000493 |
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