Reducing length of stay in patients following liver transplantation using the model for continuous improvement

BMJ Open Quality

article

Corinne Weernink¹  Melanie Dodds¹  Kelly Thomas¹  Lynne Sinclair¹  Anton Skaro¹  Mayur Brahmania²  Yashasavi Sachar²  Abdulrhman Alamr²  Alan Gob³  Ephraim Tang¹  Anouar Teriaky²  Karim Qumosani² 

[1] Department of General Surgery , Western University;Department of Medicine, Division of Gastroenterology , Western University;Center for Quality, Innovation and Safety , Western University;Department of Medicine, Division of Hematology , Western University

关键词: Healthcare quality improvement;    Surgery;    Statistical process control;    Quality improvement;   

DOI  :  10.1136/bmjoq-2022-002149

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Length of stay (LOS) is a significant contributor to overall patient outcomes for patients undergoing liver transplantation. This study documents a quality improvement project aiming to reduce the median post-transplant LOS for liver transplant patients. We instituted five Plan–Do–Study–Act cycles with the goal of reducing LOS by 3 days from a baseline median of 18.4 days over 1 year. Balancing measures such as readmission rates ensured any decrease in stay was not associated with significantly increased patient complications. Over the 28-month intervention period and 24-month follow-up period, there were 193 patients discharged from hospital with a median LOS of 9 days. The changes appreciated during quality improvement interventions carried over to sustained improvements, with no significant variability in LOS postintervention. Discharge within 10 days increased from 18.4% to 60% over the study period, with intensive care unit stay decreasing from a median of 3.4–1.9 days. Thus, the development of a multidisciplinary care pathway, with patient engagement, led to improved and sustained discharge rates with no significant differences in readmission rates.Healthcare quality improvementSurgeryStatistical process controlQuality improvementData availability statementNo data are available.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND