Ms Sarah Temby1, Mr Michael Johnson1, Associative Professor Bev Eldridge1
1The Royal Children’s Hospital, Parkville, Australia
Title:
Enhanced Outcomes Post Implementation of an Accelerated Discharge Pathway after Spinal Fusion.
Aim:
Improve outcomes for adolescents with an Idiopathic Scoliosis undergoing posterior spinal fusion.
Method:
An Accelerated Discharge Pathway (ADP) was introduced at The Royal Children’s Hospital (RCH) in January 2016 involving:
- speedier transition to oral pain medication, drinking and eating
- earlier removal of urinary catheter
- earlier mobilization
- discharge home without bowel movement.
Outcomes were measured via an audit of ADP patients in January to June 2016 (n = 19) compared with similar cohorts in 2013 (n = 17) and 2014 (n= 15) and patient satisfaction surveys (Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Hospital Survey).
Results:
No significant differences were found between patient demographic and surgical characteristics of the three patient groups.
The average length of hospital stay reduced post ADP implementation (3.4 days in January-June 2016) compared with pre-ADP (6.1 days in 2013; 6.5 days in 2014) resulting in cost reductions for nursing (38.4%), medical (72.2%) and allied health (31.5%).
The overall complication rate was low (0.05%) with 1 minor complication and no hospital readmissions.
The CAHPS Survey results post ADP implementation indicated satisfaction in multiple areas (where 100% represents maximum satisfaction):
- 92.8% for communication with parent
- 91.4% for communication with child
- 85.2% for attention to safety and comfort
- 92% global satisfaction rating
Significance of the findings to allied health:
Introduction of the ADP is the single biggest innovation in postoperative care of adolescents undergoing scoliosis surgery at RCH in the last 30 years. Findings indicate a significant impact on the patient management and reduction in costs without compromising patient safety and satisfaction.