Implementation of a direct-from-recovery-room discharge pathway: a process improvement effort.
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.
Ehrenfeld
Jesse M
JM
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Seim
Andreas R
AR
Berger
David L
DL
Sandberg
Warren S
WS
D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D019091:Critical Pathways; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D017064:Process Assessment, Health Care; D011997:Recovery Room; D012189:Retrospective Studies