Nurse-led discharge versus consulting surgeon-led discharge for patients who underwent laparoscopic surgeries: an evaluation of follow-up outcome, readmission frequencies, cost of care, and satisfaction of patients.

BACKGROUND

Consulting surgeons review admitted patients and make decisions regarding their fitness for discharge. This leads to a delay in discharge. Delayed hospital discharge is an issue faced by patients after laparoscopic surgery, which increases their morbidity. Thus, discharge for laparoscopic surgeries is a critical issue in healthcare.

OBJECTIVES

To evaluate the follow-up outcomes, readmission frequencies, cost of care, and satisfaction of patients who received nurse-led discharge compared to those of patients who received consulting surgeon-led discharge after laparoscopic surgeries.

METHODS

In a retrospective study of electronic medical records gathered from the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China, of patients who underwent laparoscopic surgery received nurse-led discharge after final medical examinations by a senior nurse (NLD cohort, n = 105) or consulting surgeon-led discharge after final medical examinations by consulting surgeons (SLD cohort, n = 156). All patients received discharge prescriptions from consulting surgeons, with instructions.

RESULTS

There were no statistical differences between patients who received nurse-led discharges and consulting surgeon-led discharges for demographic and clinical characteristics, immediate postoperative complications during hospital stays (nausea, vomiting, headache, dizziness, and postoperative pain), total consumption of tramadol during hospital stay, total hospital stay, cost of care, and satisfaction of patients after follow-up (p > 0.05 for all). Fifteen (6%) patients (3 (3%) from the NLD cohort and 12 (8%) from the SLD cohort) were readmitted. The working area for consulting surgeon-led discharges had a beneficial score of 0-0.51 (between 5 and 11% readmission rate) and the working area for nurse-led discharges had a beneficial score of 0-0.81 (between 5 and 34% readmission rate). In possibilities of more than 11% and more than 34% of readmissions rate of patients with consulting surgeon-led discharges and nurse-led discharges, respectively, had a risk of complications during follow-up.

CONCLUSIONS

Appropriate final medical examinations of patients after laparoscopic surgery are required for the decision to discharge through a nurse or consulting surgeon. Nurse-led discharge is as effective and safe as consulting surgeon-led discharge after laparoscopic surgery, in fact can improve patient care or cost efficiency.

TECHNICAL EFFICACY: Stage 5.

LEVEL OF EVIDENCE: IV.