title: Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients.
abstract: OBJECTIVE
  To determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer.
  
  
  METHODS
  Study design was a retrospective case-control study of patients undergoing major head and neck cancer resections and reconstruction at a tertiary referral centre. The intervention was rigid adherence to a pre-existing care pathway including flow algorithms and multidisciplinary checklists incorporated into patient charting and care orders. 157 patients were enrolled prospectively and were compared to 99 patients in a historical cohort. Patient charts were reviewed and information related to the patient, procedure, and post-operative course was extracted. The two groups were compared for number of major and minor complications (using the Clavien-Dindo system) and length of stay in hospital.
  
  
  RESULTS
  Comparing pre- and post-intervention groups, no significant difference was identified in duration of hospital stay (21.5 days vs. 20.5 days, p = 0.750), the rate of major complications was significantly higher in the pre-intervention cohort (25.3% vs. 14.0%, p = 0.031), the rate of minor complications was not significantly higher (34.3% vs 30.8%, p = 0.610).
  
  
  CONCLUSIONS
  Rigid adherence to our patient care pathway, and improved charting techniques including flow algorithms and multidisciplinary checklists has improved patient care by showing a significant reduction in the rate of major complications.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. dan.oconnell@ualberta.ca.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: O'Connell
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. brittanybarber0@gmail.com.
authors.forename: Brittany
authors.initials: B
authors.lastname: Barber
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. klein.max@gmail.com.
authors.forename: Max F
authors.initials: MF
authors.lastname: Klein
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta Hospital, 1E4.31 8440 112th Street NW, Edmonton, AB, T6R 2B7, Canada. jsoparlo@ualberta.ca.
authors.forename: Jeff
authors.initials: J
authors.lastname: Soparlo
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. hanimarzouki@gmail.com.
authors.forename: Hani
authors.initials: H
authors.lastname: Al-Marzouki
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. Jeffrey.Harris@albertahealthservices.ca.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. Hadi.Seikaly@albertahealthservices.ca.
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D005791:Patient Care / Q000592:standards*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome