Improving the Rate of Same-day Discharge in Gynecologic Oncology Patients with Endometrial Cancer undergoing Minimally Invasive Robotic Surgery: A Quality Improvement Initiative

Study Objective/Setting/Patients: Same-day discharge (SDD) in patients with endometrial cancer undergoing minimally invasive surgery (MIS) is safe and feasible, with multiple patient and healthcare system benefits. Despite this, our local rate of SDD was only 29.4%. Several studies have suggested methods to improve rates of SDD but few have evaluated the appli-cation of such methods. The objectives of our quality improvement (QI) initiative were 2-fold: (1) to increase the rate of SDD in eligible patients with endometrial cancer undergoing MIS to 70% and (2) to evaluate the implementation of methods to improve rates of SDD.Design/Interventions/Measurements: At our center, QI diagnostics were conducted, and root causes were identified. Four interventions were introduced: (1) setting SDD as the default discharge plan, (2) ensuring that a physician order for dis-charge was on the chart, (3) removing the Foley catheter in the operating room, and (4) introducing pre-and postoperative patient education documents. A time-series design was used; rate of SDD was tracked using baseline data and continuous post-intervention monitoring. Process measures (for each intervention) and balancing measures were defined and tracked.Main Results: At the conclusion of our QI initiative, the average rate of SDD was 78.3%-exceeding our aim of 70%. This was achieved without compromising patient satisfaction (98.2%) or significantly impacting rates of readmission or presenta-tions to the emergency department.Conclusions: Our initiative demonstrated the application of simple interventions that resulted in a substantial increase in our rate of SDD in the population of interest, without causing negative impacts on the defined balancing measures. These interventions were nonspecific to gynecologic oncology and could easily be applied across other surgical disciplines. Jour-nal of Minimally Invasive Gynecology (2022) 29, 1184-1193.(c) 2022 AAGL. All rights reserved.

Automated summary

By implementing quality improvement interventions, the rate of same-day discharge was increased from the target of 70% to 78.3%, without affecting patient satisfaction or readmission rates.