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

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

Pdf Summary

This prospective quality-improvement study evaluated a clinical effectiveness bundle for pediatric patients undergoing minimally invasive pectus excavatum (Nuss) repair at a quaternary children’s hospital. The intervention combined target-based care (TBC)—using local historical data to set and visibly display bedside recovery targets—with a multidisciplinary, evidence-based perioperative clinical pathway and an EHR-integrated order set and decision support. Historical controls (2018–2021) were compared with postintervention patients (2022–2024).<br /><br />Targets were derived from baseline cohort medians and focused on key milestones: postoperative length of stay (LOS), timing of Foley catheter removal, and discontinuation of patient-controlled analgesia (PCA). Implementation included automatic pathway enrollment, bedside target cards, nursing prompts, best-practice alerts (including when LOS exceeded target), a real-time analytics dashboard, and bimonthly multidisciplinary reviews with root-cause analysis of missed targets.<br /><br />Ninety-one patients were included (52 preintervention, 39 postintervention). 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 variability. Process improvements included shorter time to PCA discontinuation (mean 1.6 to 0.8 days) and earlier Foley removal (22.2 to 17.1 hours). Time to last IV opioid dose also fell markedly (22.9 to 4.9 hours). All postintervention patients received cryoablation versus 35% preintervention, alongside standardized multimodal analgesia and more consistent PCA stop timing.<br /><br />Thirty-day readmissions increased (6% to 10%), but none in the intervention group were for poor pain control; causes included allergic reaction, infection, pleural effusion, and bar complication. The authors conclude that integrating data-driven bedside targets with pathways and EHR tools can rapidly and sustainably reduce LOS and accelerate postoperative milestones after pectus repair.

Keywords

pectus excavatum

Nuss procedure

pediatric surgery

quality improvement bundle

target-based care

perioperative clinical pathway

EHR-integrated order set

postoperative length of stay

cryoablation analgesia

multimodal pain management