1049 Reducing Postoperative Length of Stay After Thyroidectomy by Implementing Standardized Post-Operative Pathways

Abstract

Abstract Aim Reducing length of stay programme (RLoS) was conceived to ensure better outcome and experience while preserving capacity. Our unit was an outlier in length of stay after thyroidectomy according to British Association of Endocrine and Thyroid Surgeons (BAETS) annual report. We present the results of implementation of a standardized postoperative care pathway to reduce the length of stay. Method Patient expectations were managed for an early discharge. A multidisciplinary postoperative care pathway was developed to facilitate early discharge. Protocol was well publicized among the surgical team and the nursing staff. We evaluated the implementation and efficacy of the pathway. Discharge data was collected on all total thyroidectomies prospectively over 12 months. Comparison was made with two years data of thyroidectomies prior to implementation of protocol. Results Prior to protocol implementation, 29 Thyroidectomies were done for benign disease. They were discharged, on post-operative day one 0% (67%), day two 45% (23%), day three 41% (6%), day four 0% (3%) and day five 7% (1%). Figures in parenthesis are national figures from BAETS annual report. After protocol implementation, 17 thyroidectomies were carried out for benign disease. 87% were discharged on first postoperative day and 13% on second day. No patients stayed longer than two days. There were no patient safety events as a result of implementation of protocol and early discharge. Conclusions A structured and well publicized post-operative care protocol and managing patient expectations can significantly reduce postoperative length of stay after thyroidectomy without compromising patient safety.