Diffusion of Successful Same Day Discharge Practice for Total Joint Arthroplasty Patients to a Select Population of Mastectomy Patients

Abstract

Background Information Reimbursement guided by the Centers for Medicare & Medicaid Services (CMS) inpatient-only list continues to evolve with advancements in technology, care and coordination. Hospitals face business and quality imperatives of adjusting care pathways to allow for safe, high quality discharge of surgical patients earlier than ever. A 171-bed community teaching hospital in the northeast United States wanted to develop a novel care pathway to discharge patients undergoing mastectomy without reconstruction from the post anesthesia care unit (PACU) on the day of surgery. Current practice was to discharge them from the post-op floor. With the recent success of a novel pathway for same day discharge of joint replacement patients developed on this unit, staff were quickly able to translate effective practices to this new population. Objectives of Project To develop and implement a novel care pathway to discharge same day mastectomy without reconstruction patients from the PACU while maintaining high quality and patient satisfaction. Process of Implementation Following the leadership decision to initiate PACU discharge of select mastectomy patients, a PACU nurse champion was named. She identified needed changes and collaborated with multiple members of the interdisciplinary team to create a novel care pathway. Enhancements put in place included a new standard order set developed in collaboration with the surgical Advanced Practice Provider (APP) to support top of license nursing practice, customization within the electronic health record to clarify discharge materials for patients, collaborating with the Chief of Anesthesia to develop and disseminate a post-operative pain management protocol and a dedicated physical therapy pager and space to facilitate the most efficient care. Statement of Successful Practice Since June 2020, 3 patients have been discharged via the PACU pathway. None have required change to the traditional pathway. Mean length of stay has decreased for this population from overnight stay to approximately 6 hours. Patient and surgeon satisfaction for this group is high and there has been no impact to quality metrics. Implications for Advancing the Practice of Perianesthesia Nursing The successful implementation of PACU discharge of mastectomy patients is a result of PACU nurses leading collaborative innovation. As organizations across the country explore options to decrease length of stay, PACU nurses will play an important role in addressing strategic initiatives by embracing novel care pathways.