‘Dagvård-direkt’—halving postoperative length of stay through pathway redesign
Theres Bergman, Hanna Wesslau, Ulrika JohanssonAbstract
Introduction
Breast and melanoma surgery are low-risk procedures, with approximately 1200 cases performed annually at Sahlgrenska University Hospital. Despite a large proportion of ASA I–II patients, postoperative pathways have traditionally been standardized, leading to unnecessary care transitions and prolonged recovery times. This quality improvement initiative aimed to streamline postoperative care by introducing a direct transfer pathway, reducing length of stay while maintaining patient safety.
Methods
A multidisciplinary collaboration with anesthesia was established in autumn 2024 to implement ‘Dagvård-direkt’ enabling selected patients to bypass the post-anesthesia care unit (PACU). Patients were preoperatively screened by a surgical coordinator using standardized criteria, with final intraoperative approval by the attending anesthesiologist. In spring 2026, time from end of surgery to discharge was measured and compared with a matched control group receiving standard PACU care.
Results
Forty patients were included (n = 20 per group). Mean time from end of surgery to discharge was reduced from 239 min in the control group to 117 min in the intervention group—a 51% reduction (122 min). The control group spent a mean of 94 min in the PACU, indicating that bypassing this step was a key driver of efficiency gains. No safety concerns were identified.
Discussion
‘Dagvård-direkt’ substantially reduces postoperative length of stay while simplifying the care pathway. Fewer handovers may enhance patient safety, continuity, and patient experience. The model releases critical PACU and inpatient capacity without additional resources. This scalable intervention demonstrates how targeted pathway redesign can deliver measurable impact and is transferable to other low-risk surgical populations.