Authors (including presenting author) :
Wong KL(1), Tang MYL(1), Lai PL(2)
Affiliation :
(1)Department of Surgery, Tseung Kwan O Hospital, (2)CND, HK Children Hospital
Introduction :
In view of an expected increasing trend in high occupancy rate in surgical wards. We strive to reduce the deviation of the expected date of discharge (EDD). For elective hernia (Lap/Open) and hemorrhoid cases, there were around 17% of patients average length of stay (ALOS) were longer than the EDD (2 days). Among those patients with exceeded ALOS, 40% were due to retention of urine. The usual practice of inserting a Foley catheter for drainage would significantly lengthen the ALOS as the catheter will put in-situ for at least 1 day.
Objectives :
Shorten the ALOS of the Hernia and Hemorrhoid patient and fulfill the EDD set by the Department.
Methodology :
All In-Patients in Department of Surgery undergo elective Hemorrhoid or Hernia (Lap/Open) Surgeries were recruited to the project except those cases with Foley’s catheter in-situ when arrived surgical wards. An algorithm for management of post-operative urinary retention (Hernia repair & Haemorrhoidectomy) was introduced to all nurses in Department of Surgery. Besides, nurses have to ensure an adequate pain control (e.g Assess the patient by using the Pain Management Record (MR 4114) to perform Numerical Rating Scale (NRS). All analgesics should be administered to patient when the patient is suffering from pain). In addition, nurses should provide assistance for patient’s micturition. (e.g. Providing Urinal or bedpan, helping male patient to stand up for micturition etc.)
Result & Outcome :
1. The ALOS of the Hernia and Hemorrhoid patient was significantly shortened to 1.4 days with our practice changed.
2. The EDD set by the Department was fulfilled.
Department of Surgery had total 154 cases underwent elective Hemorrhoid or Hernia (Lap/Open) Surgeries. There were 23 cases (15%) developed ROU and 20 patients void successfully after in-out catheterization. Among the 23 cases, 2 patient developed ROU in recovery room with indwell catheter was placed before he arrived to ward. Therefore, these 2 cases were excluded in our study. The successful rate is 95%. 1 patient with LUTS still failed to void after in-out catheterization. Foley catheter was inserted eventually.
17 out of 21 cases fulfilled the EDD after the in-out catheterization. 3 cases stayed for 3 to 4 days due to other medical comorbidities. 1 case still failed in-out catheterization stayed for 3 days. The average length of stay is 1.4 days.
