Fast-track Colorectal Surgery Program Reduces Hospital Length of Stay

Abstract

Fast-track programs in colorectal surgery reduce length of stay and could be considered for other surgical populations.

Fifty ways to reduce length of stay: An inventory of how hospital staff would reduce the length of stay in their hospital

“…And in addition treating patients in a joint care programme [42,43] • Surgical pre-assessment, planning the admission, post-operative care and planning a safe discharge [44], early imaging with CT, MRI, or nuclear scintigraphy, particularly on the day before or the day of admission [45] • Preventing admissions of patients not needing inpatient care [46][47][48] • Utilising specialised nurse practitioners or other advanced professionals [49][50][51] • Creating an observation unit that gives more time to decide whether or not to admit the patient [52] • Stimulating that patients initially are seen by the right specialty [53] • Performing same-day major surgery [47] • Optimising guidelines and protocols or introducing clinical pathways for specific patient groups in order to reduce the length of stay and often with improvements of quality of care • Treating patients in a fast-track or accelerated care programme [54][55][56][57][58][59][60][61][62] • Choosing a laparoscopic rather than a classic intervention (open surgery) [63][64][65][66][67][68][69][70] although readmission rates for laparoscopic treatment may be higher [71] • Implementing an acute stroke unit [72] • Being aware that consultations, transfers and fragmentation of care often lead to delays [73,74] • Reducing waiting times for examinations [8,48] • Stimulating early rehabilitation and physical activity [75]…”

Guarding the Gut

“…15 The positive outcomes associated with mobility have been shown to reduce length of stay. [13][14][15][16][17] Interventions with the ability to safely decrease length of stay are of value to the health care industry, as resources are utilized more effectively and costs can be contained.…”

“…Baird and colleagues 16 performed a retrospective medical record review comparing the outcomes of a fast-track postoperative program to a traditional care program for patients having laparoscopic colorectal surgery admitted to 2 colorectal/general surgery units. Outcomes measured included length of stay, 30-day readmission rates, and the tolerance of early diet, early ambulation, and minimal use of drains.…”

Postoperative ambulation in thoracic surgery patients: standard versus modern ambulation methods

“…Early and aggressive ambulation measures within the initial 24 h postoperative are key components in this strategy. Postoperative management strategies that include fast track methods incorporating early ambulation have been shown to be successful in multiple surgical specialties including colorectal surgery (Delaney et al , 2001; Feo et al , 2009; Lin et al , 2009; Mohn et al , 2009; Baird et al , 2010), oesophageal surgery (Jiang et al , 2009; Cerfolio et al , 2004; Orringer et al , 2007), urology (Magheli et al , 2011) and orthopaedics (Oldmeadow et al , 2006; Pearse et al , 2007). When implemented for patients following pulmonary resection, fast tracking has been shown to reduce complications, shorten hospital LOS and lessen costs (Cerfolio et al , 2001; Das‐Neves‐Pereira et al , 2009; Muehling et al , 2008; Sugarbaker et al , 2004).…”

“…Kaneda et al (2007) and Oldmeadow et al (2006) showed that aggressive approaches to early postoperative ambulation accelerated recovery and shortened LOS for patients having a lobectomy or hip surgery, respectively. Fast track methodologies that include a regimen of early ambulation following surgery provide improved outcomes (Cerfolio et al , 2001; Delaney et al , 2001; Das‐Neves‐Pereira et al , 2009; Feo et al , 2009; Jiang et al , 2009; Lin et al , 2009; Mohn et al , 2009; Baird et al , 2010). In addition, aggressive mobilization of patients in a critically ill setting has been shown to be safe and effective in improving outcomes (Kress, 2009; O’Connor and Walsham, 2009; Needham et al , 2009).…”