The Impact of an anticipated discharge date communicated by a physician assistant on length of hospital stay after major head and neck surgery

Anticipated discharge date communication by a PA in HEENT Surgery

Authors

  • PA Natalie Dies Alberta Health Services
  • Dr. Scott Murray University of Alberta Hospital
  • Dr. Andre Isaac University of Alberta
  • Dr. Vincent Biron University of Alberta Hospital
  • Dr. Daniel O'Connell University of Alberta
  • Dr. Hadi Seikaly University of Alberta
  • Dr. Jeffrey Harris University of Alberta

DOI:

https://doi.org/10.5203/jcanpa.v1i3.707

Keywords:

otolaryngology head and neck surgery (OHNS), Length of Stay, Discharge Planning

Abstract

Abstract:

Patients undergoing major head and neck (H&N) surgery require complex multidisciplinary care. Surgical ward rooms contain whiteboards primarily used by nurses. The display of an “anticipated discharge date” (ADD) may be a simple yet effective discharge tool. 

Adults following H&N resection with reconstruction were randomized into two groups: without an ADD (control) or with an ADD (intervention). For the intervention group, the physician assistant (PA) provided an ADD 48-hours prior to and documented it on the whiteboard. The PA also provided additional discharge education. On the day of discharge, all patients completed a survey examining readiness for discharge. Nurses and allied health also completed a survey examining protocol effectiveness. The primary outcome was the length of hospital stay (LOS). 

Thirty-two patients were examined. There were no statistical differences in demographics, postoperative complications, and days to tracheostomy decannulation. Median LOS was 0.5 days shorter for the intervention group (11.50 vs. 12.00, p=0.84). No patients were readmitted within 30-days and there were no mortalities. There were trends for the intervention group to better understand their hospital course and believe their discharge date was adequately communicated (p=0.18 and p=0.16). Sixty-seven percent of staff believed the ADD assisted their practice, while 83% believed the PA improved efficiency of the discharge process.

Surprisingly, providing patients an ADD did not significantly reduce LOS. Despite most patients having advanced cancer and considerable comorbidities, the 30-day readmission rate was zero. The PA improved patient education, while 66% of staff agreed on an ADD positively impacts patient care.

Author Biographies

PA Natalie Dies, Alberta Health Services

Physician Assistant, Division of Otolaryngology Head and Neck Surgery

Dr. Scott Murray, University of Alberta Hospital

Division of Otolaryngology Head and Neck Surgery

 

Dr. Andre Isaac, University of Alberta

Division of Otolaryngology Head and Neck Surgery

Dr. Vincent Biron, University of Alberta Hospital

Professor, Division of Otolaryngology Head and Neck Surgery

Dr. Daniel O'Connell, University of Alberta

Professor, Division of Otolaryngology Head and Neck Surgery

Dr. Hadi Seikaly, University of Alberta

Director, Division of Otolaryngology Head and Neck Surgery

Dr. Jeffrey Harris, University of Alberta

Professor, Division of Otolaryngology Head and Neck Surgery

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Published

2019-10-11

How to Cite

Dies, P. N., Murray, S., Isaac, A. ., Biron, V., O’Connell, D. ., Seikaly, H., & Harris, J. (2019). The Impact of an anticipated discharge date communicated by a physician assistant on length of hospital stay after major head and neck surgery : Anticipated discharge date communication by a PA in HEENT Surgery. The Journal of Canada’s Physician Assistants, 1(3), page 1–12. https://doi.org/10.5203/jcanpa.v1i3.707