Standardization of clinical care pathway leads to sustained decreased length of stay following Nuss Pectus repair: a multidisciplinary quality improvement initiative

Abstract Background and Purpose Post-operatively, standardized clinical care pathways (SCCPs) help patients reach necessary milestones for discharge. The objective of this study was to achieve 90% compliance with a pectus specific SCCP within 9 months of implementation. We hypothesized that adherence to a pectus SCCP following the Nuss procedure would decrease post-surgical length of stay (LOS). Methods A multidisciplinary team implemented the pectus SCCP, including goals for mobility, lung recruitment, pain control, intake, and output. The full protocol included 42 components, tracked using chart reviews and a patient-directed checklist. The primary process measure was compliance with the pectus SCCP. The primary outcome measure was LOS; secondary outcomes were patient charges, patient satisfaction, and hospital readmission. Results Total study patients were n = 509: 159 patients pre-intervention, 350 patients post-intervention (80 implementation group; 270 sustain group). SCCP compliance data was collected on 164 patients post-intervention – 80 implementation, 84 sustain. LOS, ED visits, hospital readmissions were recorded for all 509 patients. Mean LOS decreased from 4.5 days to 3.4 days, with > 90% adherence to the pectus SCCP post-intervention. There were no readmissions due to pain despite earlier termination of epidural analgesia. Total patient charges decreased by 30% and patient satisfaction was high. Conclusion Using quality improvement methodology with strict adherence to a pectus SCCP, we had significant reduction in LOS and patient charge without compromising effective post-operative pain management or patient satisfaction. Type of Study Clinical Research; Quality Improvement. Level of Evidence V