Post-Heart Transplant Care Pathway's Impact on Reducing Length of Stay

BACKGROUND: Prolonged length of stay (LOS) has undesirable consequences including increased cost, resource consumption, morbidity, and disruptions in hospital flow. LOCAL PROBLEM: A high-volume heart transplant center in the Pacific Northwest had a mean index hospital LOS of 23 days, with a goal of 10 days according to the institutional heart transplant care pathway. METHODS: A retrospective, regression analysis was used to identify the factors contributing to LOS of 41 post-heart transplant patients. INTERVENTIONS: The post-heart transplant care pathway and order set were modified accordingly and reintroduced to the health care team. RESULTS: Factors contributing to LOS included number of days (1) until the first therapeutic calcineurin inhibitor level, (2) until intravenous diuretics were no longer required, and (3) outside of a therapeutic calcineurin inhibitor range. The interventions reduced the mean LOS by 8 days. CONCLUSIONS: Increased awareness of LOS, education, and consistent use of care pathways can significantly reduce length of stay.