Optimizing Unilateral DIEP Flap Breast Reconstruction Leads To Decreased Hospitalization Time: A Quality Improvement Study
Carrie S. Stern, MD, Ethan L. Plotsker, BA, Jonas A. Nelson, MD, MPH, Evan Matros, MD, MPH, MMSc, Eleni Kalandranis, MSN, Dana Fatterusso, BSN, Colette Mooney, BSN, Yigu Chen, MPH, Jeena Velzen, PhD, Babak J. Mehrara, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
PURPOSE: Deep inferior epigastric perforator (DIEP) flap surgery commonly involves a multi-day hospitalization, although data suggests that 95% of complications following DIEP flap breast reconstruction occur within the first 24 hours postoperatively. We adopted Six-Sigma process improvement methodology to optimize the care of patients undergoing unilateral DIEP flaps to decrease overall hospitalization time.
METHODS: Our study functioned according to Six-Sigma's DMAIC (Define, Measure, Analyze, Improve, Control) framework, first defining stakeholders such as plastic surgeons, perioperative support services, and nursing; workgroups were defined based on their relation to the reconstructive process (intraoperative or perioperative). Measurement of baseline and post-intervention performance was conducted according to project SMART goals. Analysis of inefficiencies identified by workgroups then followed. Improvement involved creation of new interventions for quality improvement. Control entailed ongoing monitoring to ensure progress was sustained following study completion. RESULTS: Our interventions lasted 6 months and included 70 patients. Intraoperative interventions such as standardized trays did not decrease procedure time. Actively striving to advance patients through postoperative milestones during their inpatient stay and creation of an outpatient nursing roadmap that included aspects of inpatient care decreased median length of stay from 67.8 to 44.8 hours. Qualitatively, 77% of patients agreed they felt ready to be discharged when equipped with nursing instruction. No major complications were observed after earlier discharge.
CONCLUSION: A systematic DMAIC framework can decrease hospitalization time following unilateral DIEP surgery and spare resources for additional reconstructive patients. Such methodology can potentially further reduce stay and be applied to bilateral reconstruction patients.
Back to 2022 Posters