Ms Sarah Temby1, Mr Michael Johnson1, Associative Professor Bev Eldridge1
1The Royal Children’s Hospital, Parkville, Australia
Enhanced Outcomes Post Implementation of an Accelerated Discharge Pathway after Spinal Fusion.
Improve outcomes for adolescents with an Idiopathic Scoliosis undergoing posterior spinal fusion.
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).
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.