Comprehensive perioperative care program to improve same-day discharge after minimally invasive gynecologic oncology surgery (MIGOS)
A quality improvement program significantly increased same-day discharge rates after minimally invasive hysterectomy from 29% to 75% at a cancer centre without compromising safety or patient experience.
Background
Objectives: Same-day discharge (SDD) after minimally invasive hysterectomy for gynecologic conditions has been shown to be safe and feasible, but remains challenging to implement. We designed and implemented a quality improvement perioperative program to improve SDD rate from 30% to 75% over a 12-month period.
Methods: We included 102 consecutive patients undergoing minimally invasive hysterectomy at a single cancer centre during the 12-month implementation period. A historical cohort of 100 was identified for comparison of clinicodemographic variables and discharge outcomes. A team of gynecologic oncologists, anesthesiologists, and nurses developed a comprehensive perioperative care program based on Early Recover after Surgery (ERAS) principles and met bi-weekly for plan-do-study-act (PDSA) cycles. Patients were followed for 30 days after discharge. We used a run chart to monitor the effects of our interventions on outcomes and conducted a pre-post analysis to evaluate SDD rates and perioperative outcomes.
Results: Median SDD rates increased from 29% to 75% after implementation (p Conclusions: Following implementation of a perioperative quality improvement program targeted towards minimally invasive gynecologic oncology surgery, our interventions significantly improved SDD rates while maintaining low 30-day perioperative complications and excellent patient experience.
Project team
- Rachel Soyoun Kim
TRP supervisors
Project advisory committee
- Dr. Andrea Simpson, St. Michael's Hospital
- Dr. Tomer Feigenbert, Credit Valley Hospital
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