Implementation of a direct-from-recovery-room discharge pathway: a process improvement effort

Surg Innov. 2009 Sep;16(3):258-65. doi: 10.1177/1553350609339169. Epub 2009 Jul 3.


Background: The authors describe a process improvement effort to achieve direct-from-recovery-room discharge for elective laparoscopic cholecystectomy patients--without prior patient selection.

Methods: The authors developed and implemented a new pathway, and then measured the learning curve (ie, success rate over time for direct discharge) and compared patients achieving direct discharge with patients admitted after surgery.

Results: The learning curve between the first patient and steady-state performance was 56 patients. A total of 80% of patients achieved direct discharge. Directly discharged patients were younger (P<.001), had lower ASA physical status classifications (P<.005), and left the recovery room earlier in the day (P<.0001). However, elderly patients and those with high ASA scores frequently could be directly discharged from the recovery room.

Conclusions: Through small team based rapid cycle process improvement, direct-from-recovery-room discharge of laparoscopic cholecystectomy patients can be achieved in an unselected patient population with a short learning curve.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cholecystectomy, Laparoscopic
  • Critical Pathways*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge / standards*
  • Patient Discharge / trends
  • Process Assessment, Health Care*
  • Recovery Room*
  • Retrospective Studies