U.S. and Canadian Home Recovery Programs After Mastectomy
Posted: Wednesday, May 29, 2019
The findings of two studies—one based in Alberta, Canada, and the other in Davis, California—indicated the multiple benefits of separate programs that were carefully designed to make home recovery from mastectomy a satisfactory experience for patients and stakeholders alike. The results were reported at the 2019 Annual Meeting of the American Society of Breast Surgeons in Dallas.
In the province of Alberta, the same-day surgery rate rose after the program innovations from 1.2% to 40%, putting it on par with the rest of the country, and most women gave high ratings to their care experience. In California, the same-day surgery rate rose after initiation of the program from 26% to 65%, with no subsequent differences in emergency department visits or hospital readmissions.
The Alberta team committed to develop a mastectomy-related care pathway and quality improvement initiative. Lead author May Lynn Quan, MD, of the University of Calgary, and colleagues explained that each of five regional committees had six to eight local members, whose goal was to support three groups: surgeons and nurse navigators; perioperative care nurses; and patients and family members. The committees identified “opportunities along the patient care experience,” and the resultant work to fulfill those opportunities was translated into new education materials for patients (booklets, group classes, assigned nurse navigators), in-service teaching at hospitals for perioperative staff, and standardized discharge protocols and local protocols for at-home support after discharge.
In California, the Permanente Medical Group developed a mastectomy home recovery program in 2017 to serve patients across 21 medical centers, with best practices shared among all facilities. Lead author Brooke Vuong, MD, of Kaiser Permanente South Sacramento Medical Center, noted that the program incorporated preoperative patient education sessions and home-care–specific training for all care team members, including nurse navigators, breast care coordinators, and postanesthesia care unit recovery nurses.
Mastectomy surgery that involves same-day discharge is “safe and well-accepted,” noted Dr. Quan and her coauthors. “Many women feel more comfortable recuperating in a familiar environment, and risks of hospital acquired conditions are reduced,” added Dr. Vuong in an interview.
Disclosure: The study authors’ disclosure information may be found at breastsurgeons.org.