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Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3354–3360 | Cite as

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

  • Alysha R. Keehn
  • David W. Olson
  • Joseph C. Dort
  • Shannon Parker
  • Susan Anderes
  • Lynn Headley
  • Adam Elwi
  • Angela Estey
  • Alysha Crocker
  • Alison Laws
  • May Lynn QuanEmail author
Breast Oncology

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.

Notes

Acknowledgment

We would like to take the time to acknowledge the many contributions that supported this work including members of the CSCN, the Provincial Steering Committee Members, the clinical and administrative champions at the hospitals involved, and the two public advisors who sat on the Provincial Steering Committee.

Disclosures

The authors of this work have no commercial interests to disclose. This initiative was provincially funded by Alberta Health Services through the Cancer Strategic Clinical Network (SCN).

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Alysha R. Keehn
    • 1
    • 2
  • David W. Olson
    • 3
  • Joseph C. Dort
    • 1
    • 2
    • 4
  • Shannon Parker
    • 5
  • Susan Anderes
    • 5
  • Lynn Headley
    • 5
  • Adam Elwi
    • 5
  • Angela Estey
    • 5
  • Alysha Crocker
    • 6
  • Alison Laws
    • 1
  • May Lynn Quan
    • 1
    • 2
    • 4
    Email author
  1. 1.Department of Surgery, Foothills Medical CentreUniversity of CalgaryCalgaryCanada
  2. 2.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  3. 3.Department of SurgeryUniversity of AlbertaEdmontonCanada
  4. 4.Department of OncologyUniversity of CalgaryCalgaryCanada
  5. 5.Cancer Strategic Clinical NetworkAlberta Health ServicesEdmontonCanada
  6. 6.Surveillance and ReportingAlberta Health ServicesCalgaryCanada

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