JHQ 4823: Clinical Effectiveness Strategies to Improve Patient Outcomes After Pectus Excavatum Repair-JHQ 4823 Article

JHQ 4823 Article

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This prospective quality-improvement study evaluated whether a clinical effectiveness bundle—combining target-based care (TBC), a multidisciplinary clinical pathway, and electronic decision support—improved outcomes for pediatric patients undergoing minimally invasive pectus excavatum repair at a quaternary children’s hospital. TBC used local historical data to set clear bedside targets for key postoperative milestones (primary outcome: length of stay [LOS]; process measures: time to Foley catheter removal and patient-controlled analgesia [PCA] discontinuation). These targets were displayed on bedside cards to align expectations among clinicians, patients, and families, and were reinforced through an EHR order set, best-practice advisories, nursing prompts, and real-time dashboards reviewed in bimonthly multidisciplinary meetings.<br /><br />Ninety-one patients were included: 52 historical controls (2018–2021) and 39 postintervention patients (2022–2024). After implementation, median LOS decreased from about 3.0 to 1.8 days, and the proportion meeting the 2-day LOS target rose from 44.2% to 91.8%, with reduced variation in LOS. Mean time to PCA discontinuation fell from 1.6 to 0.8 days, and Foley catheter duration decreased from 22.2 to 17.1 hours. Time to last IV opioid administration also dropped markedly (22.9 to 4.9 hours). Postintervention patients who missed LOS targets most commonly did so due to pain/anxiety, constipation or delayed oral intake, or urinary retention.<br /><br />Thirty-day readmissions increased from 6% to 10%, but none of the postintervention readmissions were due to poor pain control; causes included allergic reaction, infection, pleural effusion, and bar displacement. Limitations include single-center design, small sample size, retrospective baseline data, and concurrent practice changes (notably universal cryoablation postintervention). Overall, integrating data-driven TBC with a clinical pathway and EHR tools produced immediate, sustained improvements in recovery milestones and hospital LOS.

Keywords

pectus excavatum repair

minimally invasive pediatric surgery

quality improvement bundle

target-based care (TBC)

clinical pathway multidisciplinary

electronic health record decision support

length of stay reduction

postoperative pain management PCA discontinuation

Foley catheter removal timing

cryoablation analgesia