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Implementation of a Direct-From-Recovery-Room Discharge Pathway: A Process Improvement Effort

Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts

Andreas R. Seim, PhD

Department of Computer and Information Science, Norwegian University of Science and Technology, Trondheim, Norway

David L. Berger, MD

Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts

Warren S. Sandberg, MD, PhD

Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, wsandberg{at}partners.org

Background. The authors describe a process improvement effort to achieve direct-from-recovery-room discharge for elective laparoscopic cholecystectomy patients— without prior patient selection. Methods. The authors developed and implemented a new pathway, and then measured the learning curve (ie, success rate over time for direct discharge) and compared patients achieving direct discharge with patients admitted after surgery. Results. The learning curve between the first patient and steady-state performance was 56 patients. A total of 80% of patients achieved direct discharge. Directly discharged patients were younger (P < .001), had lower ASA physical status classifications (P < .005), and left the recovery room earlier in the day (P < .0001). However, elderly patients and those with high ASA scores frequently could be directly discharged from the recovery room. Conclusions. Through small team based rapid cycle process improvement, direct-from-recovery-room discharge of laparoscopic cholecystectomy patients can be achieved in an unselected patient population with a short learning curve.

Key Words: ambulatory surgery • laparoscopic cholecystectomy • patient selection • process improvement

This version was published on September 1, 2009

Surgical Innovation, Vol. 16, No. 3, 258-265 (2009)
DOI: 10.1177/1553350609339169


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