title: Postoperative Regimentation Of Treatment Optimizes Care and Optimizes Length of Stay (PROTOCOL) after pyloromyotomy.
abstract: OBJECTIVE
  A non-standardized approach to caring for infants after pyloromyotomy for pyloric stenosis was associated with prolonged postoperative length of stay (pLOS) at our institution. We studied the impact of a standardized postoperative care protocol on pLOS, patients' clinical course, and nursing care.
  
  
  METHODS
  A retrospective chart review identified that 27% of infants who underwent uncomplicated pyloromyotomy had prolonged pLOS, defined as more than one postoperative midnight. A comprehensive postoperative care protocol was developed for infants undergoing pyloromyotomy. Patients were recruited prospectively and those with complications were excluded. A sample size of 70 in each cohort (historic and prospective) allowed 80% power to detect a 50% reduction in the proportion of patients with prolonged pLOS (α=0.05). The prospective group and historic cohort were compared using nonparametric statistics.
  
  
  RESULTS
  The historic cohort had 70 patients and the prospective cohort had 66. Protocol implementation resulted in fewer patients with prolonged pLOS, shorter time to feeds, fewer feeds to discharge, less emesis, and improved nursing documentation.
  
  
  CONCLUSIONS
  Implementation of a postoperative care protocol improved various aspects of patient care and nursing care studied. Protocols outline a patient's course and serve as a common platform for communication among care providers; they can facilitate, expedite, and enhance patient care.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Clayton
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Reisch
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sanchez
authors.affiliation: Division of Pediatric Surgery, Children's Medical Center, Dallas, TX, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Fickes
authors.affiliation: Division of Pediatric Surgery, Children's Medical Center, Dallas, TX, USA.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Portillo
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: liern.chen@baylorhealth.edu.
authors.forename: Li Ern
authors.initials: LE
authors.lastname: Chen
mesh_terms: D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D011707:Pyloric Stenosis / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies
keywords: Length of stay; Nursing care; Postoperative care; Protocol; Pyloromyotomy; Standardization