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Pesce A, Portinari M, Fabbri N, Sciascia V, Uccellatori L, Vozza M, Righini E, Feo CV. Impact of enhanced recovery program on clinical outcomes after elective colorectal surgery in a rural hospital. A single center experience. Heliyon 2024; 10:e33989. [PMID: 39071659 PMCID: PMC11282988 DOI: 10.1016/j.heliyon.2024.e33989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/06/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024] Open
Abstract
Background The main purpose was to determine the impact on postoperative outcomes of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital. Methods A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018-2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013-2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, inflammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as associated factors with both postoperative complications and prolonged hospital LoS. Results Baseline characteristics were comparable in both groups. The median adherence to ERP protocol elements was 68 % versus 12 % in the retrospective control group. The median hospital LoS in the ERP-group was significantly lower than in the pre-ERP group (5 vs. 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥30 and the traditional peri-operative protocol were the associated factors to postoperative complications, while following a traditional peri-operative protocol was the only factor associated with a prolonged hospital LoS (p < 0.0001). Conclusions Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort.
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Affiliation(s)
- Antonio Pesce
- Unit of General Surgery, Department of Surgery, Azienda Unità Sanitaria Locale of Ferrara, University of Ferrara, Ferrara, Italy
| | - Mattia Portinari
- Unit of Surgery 2, Department of Surgery, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Nicolò Fabbri
- Unit of General Surgery, Department of Surgery, Azienda Unità Sanitaria Locale of Ferrara, University of Ferrara, Ferrara, Italy
| | - Valeria Sciascia
- Unit of General Surgery, Department of Surgery, Azienda Unità Sanitaria Locale of Ferrara, University of Ferrara, Ferrara, Italy
| | - Lisa Uccellatori
- Unit of General Surgery, Department of Surgery, Azienda Unità Sanitaria Locale of Ferrara, University of Ferrara, Ferrara, Italy
| | - Michela Vozza
- Unit of Anesthesia and Intensive Care, Department of Emergency, Azienda Unità Sanitaria Locale of Ferrara, Ferrara, Italy
| | - Erminio Righini
- Unit of Anesthesia and Intensive Care, Department of Emergency, Azienda Unità Sanitaria Locale of Ferrara, Ferrara, Italy
| | - Carlo V. Feo
- Unit of General Surgery, Department of Surgery, Azienda Unità Sanitaria Locale of Ferrara, University of Ferrara, Ferrara, Italy
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Tobiano G, Chaboyer W, Tong MYT, Eskes AM, Musters SCW, Colquhoun J, Herbert G, Gillespie BM. Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review. J Clin Nurs 2024; 33:890-910. [PMID: 38013213 DOI: 10.1111/jocn.16933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
AIMS To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. DESIGN A scoping review. DATA SOURCES Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. RESULTS Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. CONCLUSION The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. IMPACT STATEMENT Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. REPORTING METHOD Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION A health consumer interpreted the data and prepared the manuscript.
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Affiliation(s)
- Georgia Tobiano
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Parklands, Queensland, Australia
| | - Mavis Ying Ting Tong
- School of Nursing and Health Studies, The Metropolitan University of Hong Kong, Kowloon, Hong Kong
| | - Anne M Eskes
- School of Nursing and Midwifery, Griffith University, Parklands, Queensland, Australia
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Selma C W Musters
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Janelle Colquhoun
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
| | - Georgina Herbert
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
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3
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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4
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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5
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Antonacci AC, Antonacci CL, Dechario SP, Husk G, Schilling ME, Cifu-Tursellino K, Armellino D, Coppa G, Jarrett M. Reducing surgical site infections after colectomy: bundle item compliance, process, and outlier identification. Surg Endosc 2022; 36:6049-6058. [PMID: 35511342 DOI: 10.1007/s00464-022-09234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to implement a checklist monitoring system and identify critical surgical checklist items associated with post-colectomy surgical site infections (SSI). The relationship between checklist compliance, infection rates, and identification of non-compliant surgeons was explored. MATERIALS AND METHODS National Health Safety Network (NHSN) data were imported annually to establish baseline incidence of post-colectomy SSI from 2016 to 2019. A colectomy checklist was used to monitor compliance for 1694 random colectomies (1274 elective; 420 emergency). Reports were generated monthly to profile system, hospital, surgeon-specific infection, and checklist compliance rates. RESULTS Checklist compliance improved in elective and emergent colectomies to > 90% for all items except oral antibiotic and mechanical bowel prep in elective cases. Annualized total SSI and organ space infection rates in elective cases decreased by 33% and 45%, respectively. Elective and emergency SSI's were reduced for Superficial Incisional Primary (SIP), Deep Incisional Primary (DIP), and Intra-Abdominal Abscess (IAB) by 66%, 60.4%, and 78.3%, respectively. Checklist compliance between low (< 3%) and high (> 3%) infection rate surgeons demonstrated significantly lower utilization of oral antibiotic prep (p < 0.03) and mechanical bowel prep (p < 0.02) in high infection rate surgeons. CONCLUSION Surgeons compliant with colectomy checklists decreased elective and emergency colectomy infection rates. Ceiling compliance rates > 95% for bundle items are suggested to achieve optimal reductions in SSIs and efforts should be focused on surgeons with NHSN infection rates > 3%. Oral antibiotic prep and mechanical bowel prep compliance rates in elective colectomy appeared to differentiate high infection rate surgeons from low infection rate surgeons.
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Affiliation(s)
- Anthony C Antonacci
- Northwell Health, 2000 Marcus Avenue, Manhasset, NY, 11030, USA.
- , New York, USA.
| | | | - Samuel P Dechario
- Institute for Spine & Scoliosis (ISS), 3100 Princeton Pike, Bldg. 1-D, Lawrenceville, NJ, 08648, USA
| | - Gregg Husk
- Northwell Health, 2000 Marcus Avenue, Manhasset, NY, 11030, USA
| | | | | | - Donna Armellino
- Northwell Health, 2000 Marcus Avenue, Manhasset, NY, 11030, USA
| | - Gene Coppa
- Northwell Health, 2000 Marcus Avenue, Manhasset, NY, 11030, USA
| | - Mark Jarrett
- Northwell Health, 2000 Marcus Avenue, Manhasset, NY, 11030, USA
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6
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Goldman L, McAlister SA, Keith A, Bone N, McSwain JM, Klineline DN, Hagedorn Wonder A. Collecting Site-Level Data on Organisms Causing Surgical Site Infections to Guide Quality Improvement. AORN J 2021; 113:389-396. [PMID: 33788227 DOI: 10.1002/aorn.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 11/07/2022]
Abstract
Surgical site infections (SSIs) negatively affect patients and health care organizations. We conducted a descriptive, correlational study at two hospitals that provide care to rural patients in one Midwestern state. The study purposes were to describe: types of organisms causing reportable organ/space SSIs that occurred within 30 days of an open or a laparoscopic abdominal surgery (N = 20), and commonalities in patient- and care-related factors to provide baseline information for site-level prevention efforts for quality improvement. We identified Escherichia coli in almost half of the SSI cases (n = 9, 45%). Common patient-related factors included ethnicity, smoking, and dirty or contaminated wounds. Common care-related factors included longer surgery times (> 60 minutes), unplanned surgeries, and procedures that involved the colon or small bowel. Personnel can use site-level data to monitor prevalent types of organisms causing SSIs, enabling an evidence-based, interdisciplinary approach to develop and test methods to enhance prevention.
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7
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Smucker L, Victory J, Scribani M, Oceguera L, Monzon R. Rural context, single institution prospective outcomes after enhanced recovery colorectal surgery protocol implementation. BMC Health Serv Res 2020; 20:1120. [PMID: 33272260 PMCID: PMC7712524 DOI: 10.1186/s12913-020-05971-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022] Open
Abstract
Background Rural hospitals face unique challenges to adopting Enhanced Recovery protocols after colorectal surgical procedures. There are few examples of successful implementation in the United States, and fewer yet of prospective, outcomes-based trials. Methods This study drew data from elective bowel resection prospectively collected, retrospectively analyzed cases 2 years prior (n = 214) and 3 years after (n = 224) implementing an ERAS protocol at a small, rural health network in upstate New York. Primary outcomes were cost, length-of-stay, readmission rate, and complications. Results The implementation required changes and buy-in at multiple levels of the institution. There was a statistically significant reduction in mean length of stay (6.9 versus 5.1 days) and per-patient savings to hospital ($3000) after implementation of ERAS protocol. There was no significant change in rate of 30-day readmissions or complications. Conclusions The authors conclude that for rural-specific barriers to implementation of Enhanced Recovery protocols there are specific organizational strategies that can ultimately yield sustainable endpoints.
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Affiliation(s)
| | | | | | | | - Raul Monzon
- Bassett Medical Center, Cooperstown, NY, USA
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8
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Lyu HG, Saadat LV, Bertagnolli MM, Wang J, Baldini EH, Stopfkuchen-Evans M, Bleday R, Raut CP. Enhanced recovery after surgery pathway in patients with soft tissue sarcoma. Br J Surg 2020; 107:1667-1672. [PMID: 32618371 DOI: 10.1002/bjs.11758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/01/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients undergoing surgery for soft tissue sarcoma have high morbidity rates, particularly after preoperative radiation therapy (RT). An enhanced recovery after surgery (ERAS) programme may improve perioperative outcomes in abdominal surgery. This study reported outcomes of an ERAS programme tailored to patients with soft tissue sarcoma. METHODS A prospective ERAS protocol was implemented in 2015 at a high-volume sarcoma centre. Patients treated within the ERAS programme from 2015 to 2018 were case-matched retrospectively with patients treated between 2012 and 2018 without use of the protocol, matched by surgical site, surgeon, sarcoma histology and preoperative RT treatment. Postoperative outcomes, specifically wound complications and duration of hospital stay, were reported. RESULTS In total, 234 patients treated within the ERAS programme were matched with 237 who were not. The ERAS group had lower wound dehiscence rates overall (2 of 234 (0·9 per cent) versus 31 of 237 (13·1 per cent); P < 0·001), after preoperative RT (0 of 41 versus 11 of 51; P = 0·004) and after extremity sarcoma surgery (0 of 54 versus 6 of 56; P = 0·040) compared with the non-ERAS group. Rates of postoperative ileus or obstruction were lower in the ERAS group (21 of 234 (9·9 per cent) versus 40 of 237 (16·9 per cent); P = 0·016) and in those with retroperitoneal sarcoma (4 of 36 versus 15 of 36; P = 0·007). Duration of hospital stay was shorter in the ERAS group (median 5 (range 0-36) versus 6 (0-67) days; P = 0·003). CONCLUSION Treatment within an ERAS protocol for patients with soft tissue sarcoma was associated with lower morbidity and shorter hospital stay.
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Affiliation(s)
- H G Lyu
- Departments of Surgery, Boston, Massachusetts, USA
| | - L V Saadat
- Departments of Surgery, Boston, Massachusetts, USA
| | - M M Bertagnolli
- Departments of Surgery, Boston, Massachusetts, USA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - J Wang
- Departments of Surgery, Boston, Massachusetts, USA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - E H Baldini
- Radiation Oncology, Boston, Massachusetts, USA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | | | - R Bleday
- Departments of Surgery, Boston, Massachusetts, USA.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - C P Raut
- Departments of Surgery, Boston, Massachusetts, USA.,Radiation Oncology, Boston, Massachusetts, USA
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9
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre-post-test study. Updates Surg 2020; 72:61-71. [PMID: 31993994 DOI: 10.1007/s13304-020-00706-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 01/28/2023]
Abstract
Adherence to evidence-based recommendations is variable and generally low. This is also followed in colorectal surgery, despite the availability of the ERAS® protocol. The aim of the study was to evaluate the effect of implementing a care pathway for perioperative care in colorectal cancer surgery on outcomes and protocol adherence. So, we performed an international pre-test-post-test multicenter study, performed in ten hospitals in four European countries. The measures used included length of stay, morbidity and mortality, and documentation and adherence on intervention and patient level. Unadjusted pre-test-post-test differences were analyzed following an analysis adjusted for patient-mix variables. Importance-performance analysis was used to map the relationship between importance and performance of individual interventions. In total, 381 patients were included. Length of stay decreased from 12.6 to 10.7 days (p = 0.0230). Time to normal diet and walking also decreased significantly. Protocol adherence improved from 56 to 62% (p < 0.00001). Adherence to individual interventions remained highly variable. Importance-performance analysis showed 30 interventions were scored as important, of which 19 had an adherence < 70%, showing priorities for improvement. Across hospitals, change in protocol adherence ranged from a 13% decrease to a 22% increase. Implementing a care pathway for colorectal cancer surgery reduced length of stay, time to normal diet and walking. Documentation and protocol adherence improved after implementing the care pathway. However, not in all participating hospitals protocol adherence improved. Only in 25% of patients, protocol adherence of ≥ 70% was achieved, suggesting a large group is at risk for underuse. Importance-performance analysis showed which interventions are important, but have low adherence, prioritizing improvement efforts.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium. .,European Pathway Association, Louvain, Belgium.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Louvain, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,University Hospitals Leuven, Louvain, Belgium
| | - Massimiliano Panella
- European Pathway Association, Louvain, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium.,Department of Quality, University Hospital Leuven, Louvain, Belgium
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