A clinical pathway in a post-anaesthesia care unit can significantly reduce length of stay and can improve post-operative outcome.
IntroductionThe aim of the study was to assess the impact of a clinical pathway implemented in a post-anaesthesia care unit (PACU) on postoperative outcomes.MethodsA patient clinical pathway which includes a nurse-driven fast track program (FTP) for uncomplicated patients and minor interventions and a medical-driven slow track program (STP) for complicated patients were implemented over a period of 2 months. A retrospective cohort study based on electronic patient records was performed to assess the effectiveness of this program on PACU and hospital length of stay (LOS) and in-hospital mortality and unplanned admission to the intensive care unit (ICU). We compared the period before and after implementation of the program. Statistical analysis was performed using the Student t test, χ2, Wilcoxon-rank test. Multivariate analysis using linear and logistic regression was performed to adjust for differences in patient demographic characteristics, co-morbidities, type of surgery and anaesthesia and emergency status between the two periods. A p≤0.05 was considered significant.ResultsPatients characteristics, ASA scores, type of anaesthesia and surgery were similar before and after implementation of the clinical pathways. We observed a decrease in PACU median length of stay for all patients from 163 min (IQR, 103–291) to 148 min (IQR, 96–270 min) (p<0.001). In ASA 1-2 patients median LOS in PACU decreased from 152 min (IQR, 102–249 min) to 135 min (IQR 91–227 min) in ASA 1-2 patients (p<0.001). Hospital LOS however remained unchanged. Overall in-hospital mortality after pathway implementation decreased for all patients from 1.7 to 0.9% (adjusted OR 0.36 (95%CI 0.22 to 0.59), p value<0.01). The number of unplanned admissions to ICU decreased also from 113 (2.8%) to 91 (2.1%) (adjusted OR 0.73 (95%CI 0.53 to 0.99); p value 0.04).ConclusionA significant reduction of LOS in PACU, in-hospital mortality and unplanned admission to ICU was observed after implementation of a clinical pathway in the PACU.IntroductionLa phase postopératoire est une phase risquée pour le patient en terme de complications. La mortalité postopératoire actuelle, tous actes chirurgicaux confondus, se situe entre 1.2 et 2.6%, alors que la morbidité est supérieure à 11%.Dans notre salle de surveillance post-interventionnel (SSPI), nous avons un flux important de patients en bonne santé habituelle ayant bénéficié d'un acte chirurgical mineur et des patients polymorbides ayant bénéficié d'une chirurgie majeure. Nous avons mis en application un programme de prise en charge des patients permettant de libérer rapidement ceux en bonne santé habituelle sur la base de critères cliniques standardisés de manière à libérer les ressources de soins nécessaires pour la prise en charge des patients à haut risque de complications.But de l’étudeLe but de cette étude était d’évaluer les bénéfices d'un programme de qualité incluant deux itinéraires cliniques distincts de prise en charge en SSPI en terme de durée de séjours en SSPI, de mortalité postopératoire et de complicat...
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