Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients

Daniel A. O’Connell, Brittany Barber, Max F. Klein, Jeff Soparlo, Hani Al-Marzouki, Jeffrey R. Harris, Hadi Seikaly

To determine if rigid adherence (where medically appropriate) to an algorithm/checklist-based patient care pathway can reduce the duration of hospitalization and complication rates in patients undergoing head and neck reconstruction with free tissue transfer. Study design was a retrospective case-control study of patients undergoing major head and neck cancer resections and reconstruction at a tertiary referral centre. The intervention was rigid adherence to a pre-existing care pathway including flow algorithms and multidisciplinary checklists incorporated into patient charting and care orders. 157 patients were enrolled prospectively and were compared to 99 patients in a historical cohort. Patient charts were reviewed and information related to the patient, procedure, and post-operative course was extracted. The two groups were compared for number of major and minor complications (using the Clavien-Dindo system) and length of stay in hospital. Comparing pre- and post-intervention groups, no significant difference was identified in duration of hospital stay (21.5 days vs. 20.5 days, p = 0.750), the rate of major complications was significantly higher in the pre-intervention cohort (25.3 % vs. 14.0 %, p = 0.031), the rate of minor complications was not significantly higher (34.3 % vs 30.8 %, p = 0.610). Rigid adherence to our patient care pathway, and improved charting techniques including flow algorithms and multidisciplinary checklists has improved patient care by showing a significant reduction in the rate of major complications.