Shared decision-making to foster same-day discharge for patients with breast cancer undergoing mastectomy with or without immediate implant-based reconstruction.

Abstract

65 Background: In 2020, over 324,500 cases of invasive and non-invasive breast cancer were diagnosed, of which 36% underwent mastectomies. The post-operative period for these breast cancer patients can be an especially taxing time, not just because of the physical recovery involved, but the associated financial toxicity a patient may face. Consideration of these factors, and a desire to optimize shared decision-making between providers, nursing staff and patients, prompted the breast team at Banner MD Anderson Cancer Center (BMDACC) to coordinate a system change in post-operative planning for mastectomy patients. Methods: Implementing same day discharge (SDD) as a quality improvement process change for breast cancer patients undergoing mastectomy with or without immediate implant-based reconstruction began in December 2018. A collaborative effort to reduce length of stay while maintaining quality and safety was the goal of the process change. Shared decision making was utilized as the methodology for the quality initiative. Open communication and honest expectations of the postoperative management allowed the patient to be actively involved and helped to remove any preconceived notions about the necessity of post-operative hospitalization. A chart review comprised of retrospective data from 2017-2018 and prospective data from 2019-2020 was performed on SDD and admitted (ADM) patients who underwent mastectomy with or without immediate implant-based reconstruction. The SDD group was contacted to voluntarily answer a survey on their outpatient surgical experience using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) .Results: The utilization of shared decision-making revealed an increase in SDD with no increase in readmission or adverse events (Table). The OAS CAHPS survey was completed by78% SDD; findings revealed 95% of patients responded positively to all questions. Conclusions: For patients undergoing mastectomy, with or without immediate implant-based reconstruction, SDD is a safe and value-based initiative that has been adopted as standard of care at BMDACC. [Table: see text]