Measuring In-Hospital Recovery After Colorectal Surgery Within a Well-Established Enhanced Recovery Pathway: A Comparison Between Hospital Length of Stay and Time to Readiness for Discharge

Balvardi, Saba; Pecorelli, Nicolò; Castelino, Tanya; Niculiseanu, Petru; Liberman, Alexander; Charlebois, Patrick; Stein, Barry; Carli, Franco; Mayo, Nancy E.; Feldman, Liane S.; Fiore, Julio F.

doi:10.1097/dcr.0000000000001061

Cited by 26 publications

(25 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…LOS is used as a primary outcome measure in most studies focused on ERAS or fast-track protocols. Recently, Balvardi et al (2018) suggested LOS could be used as a measure of in-hospital recovery with equal construct-validity as "readiness for discharge." [27].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory

Zelm

Coeckelberghs

Sermeus

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

Background Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. Methods This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. Results Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. Conclusions Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. Trial registration NCT02965794. US National Library of Medicine, ClinicalTrials.gov. Registered 4 August 2014.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Recently, Balvardi et al (2018) suggested LOS could be used as a measure of in-hospital recovery with equal construct-validity as "readiness for discharge." [27]. However, due to the small number of patients per hospital in this study (≤20), LOS (and ΔLOS) should be interpreted with caution.…”

Section: Resultsmentioning

confidence: 99%

A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory

Zelm

Coeckelberghs

Sermeus

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Discharge readiness for medically complex children is an important aspect of care and, in some cases, linked to readmissions and increased length of stays. 8,26,[32][33][34] Children with CHD discharged after a surgical intervention are at risk of hospital Clinician # 2: "But yeah, I feel like it really just comes down to scheduling, who to call, when to call, and medication issues : : : They ask a lot about support groups, too." Clinician #5: "For the younger babies, how to take care of the incisions, what sternal precautions are.…”

Section: Discussionmentioning

confidence: 99%

Post-operative discharge education for parent caregivers of children with congenital heart disease: a needs assessment

et al. 2020

View full text Add to dashboard Cite

Objective: Children with congenital heart disease (CHD) have complex unique post-operative care needs. Limited data assess parents’ hospital discharge preparedness and education quality following cardiac surgery. The goals were to identify knowledge gaps in discharge preparedness after congenital heart surgery and to assess the acceptability of an educational mobile application to improve discharge preparedness. Methods: Telephonic interviews with parents of children with two-ventricle physiology who underwent cardiac surgery 5–7 days post-discharge and in-person interviews with clinicians were conducted. We collected parent and clinician demographics, parent health literacy information and patient clinical data. We analysed interview transcripts using summative content analysis. Results: We interviewed 26 parents and 6 clinicians. Twenty-two of the 26 (85%) parents felt ready for discharge; 4 of the 6 (67%) clinicians did not feel most parents were ready for discharge. Fifteen of the 26 parents (58%) reported receiving the majority of discharge teaching on the day of discharge. Eight parents did not feel like all of their questions were answered. Most parents (14/26, 54%) preferred visual educational learning aids and could accurately describe important aspects of care. Most parents (23/26, 88%) and all 6 clinicians felt a mobile application for post-operative care education would be helpful. Conclusions: Most parents received education on the day of discharge and could describe the information they received prior to discharge, although there were some preparedness gaps identified after discharge. Clinicians and parents varied in their perceptions of the readiness for discharge. Most responses suggest that a mobile application for discharge education may be helpful for transition to home.

show abstract

“…The exact quality indicators of ERAS protocols are yet to be defined, but it is obvious that LOS is not necessarily the main endpoint. Fit-for-discharge as a parameter can be more reliable than LOS [112] . The ERAS Society recommends also considering morbidity and mortality, need for transfusions, duration of surgery, readmission rate and total cost.…”

Section: Quality Controlmentioning

confidence: 99%

Enhanced recovery after rectal surgery: what we have learned so far

Tebala¹,

Gordon–Dixon²,

Imtiaz³

et al. 2018

MIS

View full text Add to dashboard Cite

Enhanced recovery after surgery (ERAS) protocols are gradually becoming the gold standard in the perioperative management of rectal patients. It is a multimodal and multidisciplinary approach that has the great merit to involve and empower the patient and bring him or her back to the centre of the strategy of care. If applied correctly, ERAS can improve the postoperative recovery, reduce the rate of complications and reduce the postoperative length of stay, in patients who had extensive pelvic dissection. The factors within ERAS and their application do not represent rigid schematizations but fluid concepts that may undergo substantial changes as soon as new evidence becomes available. The ERAS principles must be adapted to the specific environment and each team is expected to set up their own programme and quality control criteria. In this comprehensive review, the latest evidence and trend on enhanced recovery after rectal surgery have been critically appraised and presented.

show abstract

Measuring In-Hospital Recovery After Colorectal Surgery Within a Well-Established Enhanced Recovery Pathway: A Comparison Between Hospital Length of Stay and Time to Readiness for Discharge

Cited by 26 publications

References 39 publications

A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory

A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory

Post-operative discharge education for parent caregivers of children with congenital heart disease: a needs assessment

Enhanced recovery after rectal surgery: what we have learned so far

Contact Info

Product

Resources

About