我们的质量改进 (QI) 计划的目标是 (1) 将符合条件的妇科肿瘤 (GO) 患者的当日出院率 (SDD) 提高到 70%，以及 (2) 评估 QI 方法证明的难易程度一项研究可以在另一个中心应用。使用了干预前/干预后设计（50 名患者/组）。接受微创 GO 手术的患者的 SDD 是最近的趋势，与加速康复外科 (ERAS) 原则一致。根据最近的几项研究，GO 中的 SDD 是安全可行的，其中包括艾伯塔省埃德蒙顿的 QI 倡议，该项目的 SDD 率 > 70%。我们中心（艾伯塔省卡尔加里）对 GO 患者进行的基线审计发现，SDD 率为 14%。鉴于埃德蒙顿和我们的中心位于同一省内，他们有相似的患者群体和可用资源，这表明埃德蒙顿 QI 计划的干预措施可能是可转化的。四项干预措施旨在解决 QI 诊断后确定的 SDD 失败的根本原因：（ 1) SDD作为默认出院计划，包括“日间手术”手术预约； (2和3) ERAS SDD术前和术后医嘱集的制定和实施； (4) 患者教育 SDD 特定文件。SDD 率与患者人口统计数据和手术结果一起测量。定义并跟踪流程和平衡措施。实施上述干预措施后，GO 的 SDD 从 14%（50 人中的 7 人）增加到 82%（50 人中的 41 人）（比值比 [OR]，28；p <.001；95% 置信区间 [CI] ，9.54-82.11）。 SDD 的改善并未对术后急诊就诊率产生负面影响：干预前 7 天内为 8%，干预后为 4%（OR，0.48；p = .678；95% CI，0.09-2.74）；干预前和 10 天内分别为 12%干预后 30 天内的百分比（OR，0.8148；p = 1.001；95% CI，0.2317-2.86）。该 ERAS QI 举措导致 GO 中的 SDD 大幅增加，而不对平衡措施产生负面影响。我们证明，跨中心（患者群体相似）“传播”简单、明确定义的 QI 干预措施是可行的。这表明针对 GO 的 ERAS SDD 计划对于具有类似特征的其他中心来说可能是一个现实的目标。Crown 版权所有 © 2024。由 Elsevier Inc 出版。保留所有权利。

The objectives of our quality improvement (QI) initiative were (1) to increase the rate of same-day discharge (SDD) in eligible gynecologic oncology (GO) patients to 70% and (2) to evaluate the ease with which QI methods demonstrated in one study could be applied at another center.A pre-/postintervention design was used (50 patients/group).SDD in patients undergoing minimally invasive GO surgery is a recent trend aligned with Enhanced Recovery After Surgery (ERAS) principles. SDD in GO is safe and feasible based on several recent studies, including a QI initiative in Edmonton, Alberta, which resulted in SDD rates >70%.A baseline audit of GO patients at our center (Calgary, Alberta) found the SDD rate to be 14%. Given that Edmonton and our center are within the same province, they have similar patient populations and available resources-suggesting that interventions from the Edmonton QI initiative may be translatable.Four interventions were designed to address root causes for failed SDD identified after QI diagnostics: (1) SDD as the default discharge plan, including a "Day Surgery" surgical booking; (2 and 3) development and implementation of ERAS SDD preoperative and postoperative order sets; and (4) patient education SDD-specific documents.Rate of SDD was measured together with patient demographics and surgical outcomes. Process and balancing measures were defined and tracked. SDD in GO increased from 14% (7 of 50) to 82% (41 of 50) after the implementation of the above-mentioned interventions (odds ratio [OR], 28; p <.001; 95% confidence interval [CI], 9.54-82.11). Improved SDD was achieved without negatively affecting postoperative rates of emergency department visits: 8% pre- and 4% postintervention within 7 days (OR, 0.48; p = .678; 95% CI, 0.09-2.74) and 12% pre- and 10% postintervention within 30 days (OR, 0.8148; p = 1.001; 95% CI, 0.2317-2.86).This ERAS QI initiative resulted in a substantial increase in SDD in GO, without a negative impact on balancing measures. We demonstrate that the "spread" of simple, clearly defined QI interventions across centers (where the patient population is similar) is feasible. This suggests that an ERAS SDD program for GO could be a realistic goal for other centers with similar characteristics.Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.