Decreasing Postanesthesia Care Unit Length of Stay for Carpal Tunnel Release Patients: A Quality Improvement Initiative.

PURPOSE: The purpose of the project was to reduce the occurrence of nonclinical delays resulting in increased postanesthesia care unit length of stay for carpal tunnel release patients in an ambulatory orthopedic surgery center through the implementation of new workflow processes in both the preoperative and postoperative phases of care.

DESIGN

Pre-post design, with data being analyzed both before and after implementation of evidence-based quality improvement measures to assess for effectiveness of project interventions.

METHODS

At the ambulatory orthopedic surgery center, preintervention data were gathered for 6 months on carpal tunnel release patients (n = 185) to determine the root causes of discharge delays (January to June 2023). Subsequently, the following evidence-based workflow processes were implemented: the provision of preoperative discharge instructions to the patient, clearly delineated expectations for family members during their stay, early presence of family to the bedside during phase 1 of recovery, and extensive staff education. Postintervention data (n = 189) were collected on a biweekly basis throughout the 6 months of project implementation (September 2023 to February 2024) and were analyzed using the paired t test for statistical significance.

FINDINGS: The average length of stay decreased from 44.45 to 37.07 minutes with an increase in the percentage of patients meeting discharge goals from 13.5% to 35.4%. This is a statistically significant improvement in length of stay (P < .0001).

CONCLUSIONS

Interventions to maintain efficiency such as preoperative discharge teaching, early family presence at bedside, and clear expectations for family member participation can collectively contribute to a decrease in non-anesthesia-related delays and subsequently reduce postanesthesia care unit length of stay.