Expedited discharge in uncomplicated acute appendicitis: Decreasing the length of stay while maintaining quality.

BACKGROUND: An expedited discharge protocol for uncomplicated appendicitis was developed at a Canadian academic hospital to determine if patients could be safely discharged home early without negatively impacting care and patient satisfaction. METHODS: A non-randomized prospective quality improvement project was completed between February 01, 2017 and January 31, 2018. The project included patients between 16 and 65 years with uncomplicated appendicitis managed with laparoscopic appendectomy. The primary outcome was average length of stay post PACU. 30 day ED visit, cross-sectional imaging and readmission rate were balancing measures. The CTM-3 tool was used to measure patient satisfaction. RESULTS: 450 patients had emergent laparoscopic appendectomy. 287 (63.8%) patients met the project inclusion criteria. The average length of stay decreased 41.0% to 13.1 h. The 30 day ED visit, cross-sectional imaging and readmission rate were 9.8%, 4.5% and 1.0% respectively compared with 8.1%, 4.5% and 2.5% at baseline. Patient satisfaction was 3.72/4 compared to 3.74/4. CONCLUSION: An expedited discharge after an uncomplicated laparoscopic appendectomy is safe and feasible without a negative impact on 30-day ED visit, diagnostic imaging or readmission.

Can we improve the efficiency of care in patients with colorectal cancer from the time of their initial referral for colonoscopy to surgical resection?

Summary: Delays in the diagnosis and treatment of colon adenocarcinoma are distressing to patients and clinicians alike. Of 224 patients with resected colon cancer identified via a province-wide administrative database, 170 (76%) received their colonoscopy from a gastroenterologist (GI). Patients waited significantly longer between their colonoscopy and surgical resection when the colonoscopy was performed by a GI within an urban city (43 v. 27 d; p = 0.02). The total time from family practice referral to colonoscopy to surgical resection was shorter when a surgeon performed colonoscopy within an urban setting (105 v. 114 d; p = 0.03). In community settings, there were no significant differences in any interval, regardless of which service performed the colonoscopy.

Interexaminer reliability of the hip extension test for suspected impaired motor control of the lumbar spine.

OBJECTIVE: The hip extension test may be a clinical sign of impaired motor control in the lumbar spine, which may have a negative impact on spine stability. The purpose of this study is to evaluate the interexaminer reliability of the hip extension test for suspected dynamic instability of the lumbar spine in patients with chronic low back pain. METHODS: Forty-two patients with chronic low back pain participated in this interexaminer reliability study. Chronic low back pain was defined as pain of greater than 7 weeks duration in the area between T12 and the buttocks, with or without leg pain. Two doctors of chiropractic simultaneously observed and independently assessed the left and right prone hip extension test on all 42 patients. Results for both examiners were given to an independent recorder. Each examiner was blinded to the results of the other examiner. RESULTS: The mean age of subjects was 38 years (SD 12.35); 73.8% were female. Sixty-eight percent (SD 1.72) reported current back pain intensity greater than 5 on an 11-point numerical rating scale. The mean score for the Roland-Morris Low Back Pain and Disability questionnaire was 5.8 (SD 4.34). The kappa measure of agreement was 0.72 for the left leg and 0.76 for the right leg. This indicated a substantial strength of agreement between examiners for both left and right hip extension tests. For the 8 cases of disagreement, rater 1 generally rated the tests as positive, whereas rater 2 consistently rated the tests as negative. CONCLUSIONS: The hip extension test appears to have good reliability in detecting deviation of the lumbar spine from the midline. Validity with regard to the test's ability to distinguish patients with chronic low back pain from normal individuals and its relation to lumbar spine stability remains to be determined.