Optimizing discharge decision‐making in colorectal surgery: a prospective cohort study of discharge practices in a recently implemented enhanced recovery pathway. (9th February 2021)

• Record Type: Journal Article
• Authors: Caminsky, Natasha G.; Hamad, Doulia; He, Billy Haitian; Zhao, Kaiqiong; Al Mahroos, Mohammed; Feldman, Liane S.; Lee, Lawrence; Boutros, Marylise; Fiore, Julio F.
• Is Part Of: Colorectal disease. Volume 23:Number 6(2021)
• Page Start: 1507
• Page End: 1514
• Publication Date: 2021-02-09
• Subjects: colorectal surgery -- discharge criteria -- enhanced recovery -- hospital discharge -- length of stay -- postoperative period; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15525
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: The objectives of this project were (1) to compare time to readiness for discharge by set criteria and actual length of stay (LOS) in a newly implemented colorectal enhanced recovery pathway and (2) to identify reasons for delayed hospital discharge. Method: We conducted a prospective cohort study of 73 adult patients (age 67 ± 14 years, 56% men, 51% laparoscopic, 13% stoma creation) undergoing elective colorectal surgery in a university hospital with a recently implemented recovery pathway (<2 years). Time to readiness for discharge (oral intake, flatus, pain control, ability to walk, and no complications) was compared to actual LOS using a correlation‐adjusted log‐rank test. The treating team was interviewed, and thematic analysis was used to identify reasons for patients remaining in hospital after discharge criteria (DC) were achieved. Results: Median LOS was 6 (4–8) days and median time to readiness for discharge was 5 (3–8) days ( P < 0.001). Twenty‐eight patients (37%) remained in hospital after DC were achieved. Although some delayed discharges were medically justified (e.g., workup [13%] or treatment of complications not captured by DC [2.6%]), unnecessary hospital stays were common (e.g., perceived need for observation [16%], or patients not willing to be discharged [11%]). Conclusions: Unnecessary hospital stays were common within a recently implemented enhanced recovery pathway and represent a target for quality improvement. Efforts should be directed at optimizing patient education regarding discharge expectations, early consultation of the discharge planning team and improving discharge decision‐making using standardized DC.