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
DOI:
https://doi.org/10.5203/jcanpa.v1i3.707Keywords:
otolaryngology head and neck surgery (OHNS), Length of Stay, Discharge PlanningAbstract
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.
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Copyright (c) 2019 PA Natalie Dies, Dr. Scott Murray, Dr. Andre Isaac, Dr. Vincent Biron, Dr. Daniel O'Connell, Dr. Hadi Seikaly, Dr. Jeffrey Harris
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