Target-Based Care: An Intervention to Reduce Variation in Postoperative Length of Stay - 17/12/20
, Isabelle J. Rao, MS 3, Hannah K. Bassett, MD 1, Whitney Chadwick, MD 1, Joseph Kim, MD 1, Alaina K. Kipps, MD, MS 1, Komal Komra, MD 4, Ling Loh, MPH 2, Katsuhide Maeda, MD 5, Monica Mafla, NP 1, Laura Presnell, NP 1, Paul J. Sharek, MD, MPH 6, Katherine M. Steffen, MD 1, David Scheinker, PhD 1, 6, Claudia A. Algaze, MD, MS 1Abstract |
Objectives |
To derive care targets and evaluate the impact of displaying them at the point of care on postoperative length of stay (LOS).
Study design |
A prospective cohort study using 2 years of historical controls within a freestanding, academic children's hospital. Patients undergoing benchmark cardiac surgery between May 4, 2014, and August 15, 2016 (preintervention) and September 6, 2016, to September 30, 2018 (postintervention) were included. The intervention consisted of displaying at the point of care targets for the timing of extubation, transfer from the intensive care unit (ICU), and hospital discharge. Family satisfaction, reintubation, and readmission rates were tracked.
Results |
The postintervention cohort consisted of 219 consecutive patients. There was a reduction in variation for ICU (difference in SD −2.56, P < .01) and total LOS (difference in SD −2.84, P < .001). Patients stayed on average 0.97 fewer days (P < .001) in the ICU (median −1.01 [IQR −2.15, −0.39]), 0.7 fewer days (P < .001) on mechanical ventilation (median −0.54 [IQR −0.77, −0.50]), and 1.18 fewer days (P < .001) for the total LOS (median −2.25 [IQR −3.69, −0.15]). Log-transformed multivariable linear regression demonstrated the intervention to be associated with shorter ICU LOS (β coefficient −0.19, SE 0.059, P < .001), total postoperative LOS (β coefficient −0.12, SE 0.052, P = .02), and ventilator duration (β coefficient −0.21, SE 0.048, P < .001). Balancing metrics did not differ after the intervention.
Conclusions |
Target-based care is a simple, novel intervention associated with reduced variation in LOS and absolute LOS across a diverse spectrum of complex cardiac surgeries.
Le texte complet de cet article est disponible en PDF.Keywords : clinical effectiveness, congenital heart surgery, achievable benchmarks in care
Abbreviations : ACU, EHR, ICU, LOS, LPCH
Plan
| The authors declare no conflicts of interest. |
Vol 228
P. 208-212 - janvier 2021 Retour au numéro
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