Hospital length of stay
In the first 10 months of operating the service we saw a reduction in mean length of stay from 12.2 days to 8.5 days. This equated to a saving of 303 bed days in a cohort of 82 patients alone. The increase in number of laparsopic surgeries was demonstrated to not have impacted upon the length of stay reduction. We are continuously monitoring our length of stay data and have continued to show improvements in this area.
Critical care utilisation
We not only reduced the number of planned critical care admissions following the introduction of our protocols but also the mean length of stay in critical care itself. There has also been a reduction in unplanned critical care admission rates.
In our first yeat we showed an improvement in cardiovascular and pulmonary complication rates and an overall fall in major and minor complications.
Protocol Alloaction and Adherance
In the first year the service was running (2015/16) a number of patients did not recieve the protocol they had been allocated to in their pre-operative period due to bed avalibility. The decision was taken on the day of surgery to proceed with a lower intensity bed rather than cancel a cancer related surgery. The mean length of stay of patients in this group was higher than the local average. This was addressed in our second year of operation and consequently we now are now better at 'upgrading' patients and sending them to the nurse enhanced unit with additional monitoring.
Delayed discharges from recovery
As we have reduced the number of elective post-operative critical care admissions there was a query of whether this would have a negative impact on recovery with patients spending over the 2 hours reccomended by the AAGBI (2013) in recovery. An audit was perfromed and no negative impact in recovery was found, infact a small drop in both total number and overall % of stays over 2 hours was found following the introduction of the perioperative pathways.
We conducted staff surveys and found that staff felt the service had improved patient care while not increasing workload significantly.