The following article features coverage from the 2018 Oncology Nursing Society’s Annual Conference in Washington, DC. Click here to read more of Oncology Nurse Advisor‘s conference coverage. 

WASHINGTON, DC — Bypassing the surgical intensive care unit (SICU) and reducing the length of stay may improve outcomes for patients with head and neck cancer (HNC) after surgery, a study presented at the 2018 Oncology Nursing Society (ONS) Annual Congress has shown.

Although HNC surgery is a major procedure, many patients are admitted to SICU directly from the post-anesthesia care unit (PACU) for 24 to 48 hours as they require frequent monitoring of vital signs and flap perfusion before being transferred to the surgical oncology unit (SO), prolonging the length of stay. “The postoperative care for these patients can be very labor intensive since the monitoring is hourly,” said Cara Henderson, RN, BSN, CMSRN, a patient service manager in surgical oncology. “We needed to look at a way how we can accomplish this in the inpatient setting with surgical oncology.”

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For this study, a specialized nursing care unit was incorporated into SO, allowing direct transition from PACU and bypassing the SICU. An interdisciplinary team worked to select appropriate candidates for the study, and the surgeons educated the unit staff on the surgical procedure and postoperative care. 

After 2 years, results showed that not only was hospital stay shortened by 3 days (10 days vs 7 days), only 6% of patients were sent to the SICU from the PACU (100% pre-implementation), and the rate of readmission decreased from 16% to 3%. 

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The total healthcare cost was reduced by 50%, the rate of nosocomial infections was improved as well; overall patient outcomes were improved. 

Henderson concluded that “Reduction in length of stay improves patient outcomes and has tremendous impact on the institution. Maximizing resources and building competency amongst a team led to a permanent change in practice that reduced surgical complications and readmission rates.”


Henderson C, Carafeno T, Mehra S. Bypassing the SICU: free flaps to floor results in improved patient outcomes. Oral presentation at: ONS 43rd Annual Congress; May 17-20, 2018; Washington, DC.