A Fast Track Pathway in Acute Care Surgery at an Academic Medical Center
*Amanda Fazzalari1,2, *Shruthi Srinivas1, *Natalie Pozzi2, *Reeti Sheoran1, *Joseph Sabato1, *Dawn Durocher1, *Martin Reznek1, *Francesco Aiello1, Demetrius Litwin1, Mitchell A. Cahan1
1University of Massachusetts Medical School, Worcester, MA;2Saint Mary's Hospital, Waterbury, CT
Objective: Fast Track Pathways (FTPs) directed at reducing hospital length of stay (LOS) and overall costs for elective procedures are being increasingly implemented for urgent surgeries. The objective of this study is to evaluate the impact of a FTP for Acute Care Surgery at an academic medical center.
Design: Case control.
Setting: Academic Medical Center.
Patients: The study included adult patients (N=165) enrolled in a FTP who underwent laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), or laparoscopic inguinal hernia repair (LI) between September-December 2018(n=89). The control group included patients who underwent LA, LC, or LI between October-December 2016(n=76), prior to FTP implementation. The sample was 47.9% female, with a mean age of 42.1 years.
Main Outcome Measures: TTS, LOS, post-operative LOS, and readmissions were compared between groups. Direct costs, reimbursements, and patient satisfaction (reported as frequency 1=never to 4=always) were also compared.
Results: Case distribution in the FTP group was 56.2% LA, 40.1% LC, and 3.3% LI, compared to 42.1% LA and 57.9% LC in the control group. TTS was similar between groups (11h48m vs 10h02m, p<0.633). LOS was significantly shorter in the FTP group(15h17m vs 29h09m, p<0.001), reflected by shorter post-operative LOS(3h11m vs 20h10m, p<0.001), fewer patients requiring overnight stay in a hospital bed (p<0.001), and lower direct costs(p<0.001). Reimbursements were similar in both groups (p=0.088). There were no readmissions in the FTP group and average patient satisfaction was 3.3/4.
Conclusions: In an era focused on optimizing resources and ensuring patient satisfaction, a FTP can play a significant role in ACS. At an academic medical center, a FTP significantly decreased LOS, hospital bed utilization, and direct costs, while not impacting reimbursement or patient satisfaction.
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