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Reducing PACU LOS for HoLEP Same-day Discharges with a Nurse Driven Protocol
Tashzna Jones, MD, Jalfon Michael, MD, Christopher Hayden, MD, Benjamin Press, MD, Amir Khan, MD, Lokeshwar Soum, MD, MBA, Mursal Gardezi, MD, Syed Rahman, MD, Daniel Kellner, MD.
Yale School of Medicine, New Haven, CT, USA.

Background: Holmium laser enucleation of the prostate (HoLEP) has emerged as a highly effective option for the surgical management of BPH, which can be performed on a wide range of prostate sizes. iAt our institution, we have transitioned to same day discharges for the majority of our HoLEP patients, however we noticed a trend towards prolonged post anesthesia care units (PACU) durations of several hours for our same day discharges. We postulated that with the implementation of a clear and concise PACU order set, with detailed nursing instructions, that PACU duration on average could be reduced.
Materials and Methods: As part of our quality improvement initiative, an EPIC order set was created, which focused on giving nurses autonomy to troubleshoot challenges and assess a patient's readiness for discharge. The EPIC order set was designed with a focus on continuous bladder irrigation (CBI) duration, need for manual irrigation, and assessing readiness for discharge after CBI was clamped. The order set was launched on May 15th, 2022. PACU duration was analyzed before and after the order set was launched.
Results: From January 1, 2021 to October 12, 2022, we identified 221 cases pre-intervention and 73 cases post-intervention for same day discharges. The mean PACU LOS for the pre-intervention group was 162.59(mins) and 144.94 for the post-intervention group. The mean difference was 17.64 with a p-value of 0.005. A secondary analysis to determine if the implementation of our intervention could increase the odds of a same day discharge for all our HOLEP patients was performed. For the pre-intervention cohort, 221 patients were discharged the same day and 94 were admitted. For the post-intervention, there were 73 same day discharges and 35 admitted patients. The odds of being discharged the same day following the launch of the order set was 1.127 (95% CI 0.705-1.803).
Conclusion: After the implementation of our nurse driven PACU order set, we were able to demonstrate a statistically significant decrease in PACU duration. While there was no difference observed in the odds of same day discharge, this abstract highlights the utility of a nursing driven protocol to decrease the duration of PACU stays in the same day discharge of patients after HoLEP surgery.

Table 1: Group Statistics in the pre-intervention vs post-Intervention groups measured in mins
Pre-Intervention vs Post-InterventionNMeanStd. DeviationStd. Error Mean

Table 2: T-test analyzing the means of the pre vs post intervention groups
p-valueMean DifferenceStd. Error Difference95% Confidence Interval of the difference (Lower)95% Confidence Interval of the difference (Upper)
PACU LOS (Min)0.00517.645706.284525.2768330.01458

Endnotesi Cornu, J.N., et al., A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol, 2015. 67(6): p. 1066-1096.

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