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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Same-Day Surgery for Mastectomy Patients in Alberta: A Perioperative Care Pathway and Quality Improvement Initiative

Alysha R. Keehn MD, David W. Olson MD FRCSC, Joseph C. Dort MD FRCSC MSc, Shannon Parker RN, Susan Anderes RN, Lynn Headley RN MN, Adam Elwi PhD, Angela Estey MA, Alysha Crocker MSc, Alison Laws MD, May Lynn Quan MD MSc FRCSC
Breast Oncology
Volume 26, Issue 10 / October , 2019

Abstract

Background

Same-day surgery (SDS) following mastectomy is safe and well accepted. Overnight admission in patients fit for discharge is an inefficient use of health resources. In response to a national review highlighting SDS following mastectomy at 1.4% in Alberta, a perioperative pathway was conceived.

Methods

The pathway was implemented across Alberta at 13 hospitals beginning in 2016. A steering committee was assembled, and clinical and administrative leads at each site were identified. Opportunities along the patient care experience whereby action could be taken to promote uptake of SDS were identified. Provincially branded support materials including presentations, order sets, and standard operating procedures were developed. Nurse educators provided in-service teaching such as standardized drain care and discharge teaching. Educational booklets, group classes, and online resources were developed for patients and families. An audit of SDS rates, unscheduled return to the emergency department (ED), and readmission rates was reported to teams quarterly, allowing for iterative modifications. Patient-reported experience measures (PREMs) were collected.

Results

SDS following mastectomy increased from 1.7 to 47.8%, releasing an estimated 831 bed days per year. No differences in unexpected return to the ED or readmission to hospital existed between SDS patients and those admitted overnight. A total of 102 patients completed the PREM survey, of whom 90% felt “excellent or good” with the plan to go home, how to care for themselves once home, and who to contact should issues arise.

Conclusions

Implementation of a provincial perioperative pathway improved uptake of SDS following mastectomy and demonstrated favorable PREMs.

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