Transitions In Care: Implementing Short Stay Care for Rapidly Increasing Laparoscopic Procedures

Purpose for the program: The rapidly growing advancement of minimally invasive surgeries prompted the inpatient GYN unit to adapt a more formal approach to care for this population. The laparoscopic technique for hysterectomy required modification to the practice of Laparoscopic  from Total Abdominal or Vaginal Hysterectomies. The patients were expected to stay a shorter period of time; however, nursing had not modified its practices.

Proposed change: The GYN unit modified many practices to ensure that the patients were cared for appropriately after laparoscopic hysterectomy. This required collaboration with the physicians to modify the current orders and teaching tools. 

Implementation, outcomes and evaluation: The nurses were educated on the surgical procedures and the effects on the patient. Nursing modified its documentation and educational tools.  Physicians performed educational in services to help educate the staff on understanding some of the differences the patient might experience. In addition, there were unique pain issues identified that needed to be addressed. The unit worked with the Attendings and Anesthesiologist to develop specific orders to help meet the patients needs.  There was collaboration between the Post Anesthesia Care Unit and the GYN unit to be sure the interventions occurred in a timely manner to assist in a shortened length of stay.Some of the outcome measures that were collected include: LOS, Readmissions, Infections, and Patient Satisfaction. In addition to patient outcomes, nursing and physician satisfaction were measured.

Implications for nursing practice: The process followed for adapting a rapidly changing practice can be utilized in any field. The practice changes can be replicated to assist with the changing approach to hysterectomy, particularly pain management.  

Keywords: hysterectomy, laparoscopic, rapid practice changes