preprints.org > public health and healthcare > public health and health services > doi: 10.20944/preprints202104.0787.v4

Preprint Article Version 4 Preserved in Portico This version is not peer-reviewed

Version 1 : Received: 28 April 2021 / Approved: 30 April 2021 / Online: 30 April 2021 (11:55:58 CEST)
Version 2 : Received: 2 September 2021 / Approved: 3 September 2021 / Online: 3 September 2021 (11:36:31 CEST)
Version 3 : Received: 30 May 2022 / Approved: 31 May 2022 / Online: 31 May 2022 (09:10:19 CEST)
Version 4 : Received: 3 October 2022 / Approved: 3 October 2022 / Online: 3 October 2022 (12:14:56 CEST)
Version 5 : Received: 31 January 2023 / Approved: 1 February 2023 / Online: 1 February 2023 (11:47:37 CET)

Hospital bed shortage is a worldwide concern. Beds unavailability has caused elective surgery cancellations, at our hospital peaking in spring 2016 at over 50%. This is often due to difficult patient step-down from intensive care (ICU) and high-dependency units (HDU). In our general/digestive surgery service admitting approximately 1000 patients yearly, ward rounds were run on a consultant firm basis. We report a quality improvement (ISRCTN13976096) introducing in our service a structured daily multi-disciplinary board round framework (SAFER Surgery R2G) adapted from the “SAFER patient flow bundle” and the "Red to Green days” approaches to enhance flow, comparing the previous year to 2017, when our framework was applied for 12 months.We used a Plan-Do-Study-Act (PDSA) methodology. Our intervention consisted in 1) systematic communication of the key care plan after the afternoon ward rounds to the nurse in charge; 2) 30’ 10AM Monday-to-Friday multidisciplinary board rounds, attended daily by the senior-team and weekly by hospital and site managers, revising the key care plan aiming at safe, early discharges, assessing the appropriateness of each inpatient day and tackling any cause of delay. We measured patient flow by average length of stay (LOS), ICU/HDU step-downs and operation cancellations count, monitoring safety through early 30-day readmissions. Compliance was assessed by board round attendance and staff satisfaction rate surveys.After 12 months (PDSA 2, N=1032), LOS significantly decreased from 7.2(±8.9) to 6.3(±7.4) days (p=0.003); ICU/HDU bed step-down flow increased by 9.3% from 345 to 375 (p=0.197), surgery cancellations dropped from 38 to 15 (p=0.100). 30-day re-admissions increased from 0.9% (N=9) to 1.3% (N=14)(p=0.390). Average cross-specialty attendance was 80%. Satisfaction rates were >75%, regarding enhanced teamwork and faster decisions.The SAFER Surgery R2G framework has shown an increase in patient flow in the context of an enhanced multidisciplinary approach, requiring senior staff commitment to remain sustainable.

Patient flow; Surgery; Quality improvement

Public Health and Healthcare, Public Health and Health Services

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