A Collaborative for Implementation of an Evidence-Based Clinical Pathway for Enhanced Recovery in Colon and Rectal Surgery in an Affiliated Network of Healthcare Organizations

Larson, David W.; Lovely, Jenna K.; Welsh, Jesse; Annaberdyev, Sho; Coffey, Chris; Corning, Cybil; Murray, Bret; Rose, Douglas F.; Prabhakar, Lawrence P.; Torgenson, Marcus; Dankbar, Eugene C.; Larson, Mark V.

doi:10.1016/j.jcjq.2017.08.007

Cited by 11 publications

(20 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While mean LOS decreased by 2.1 days, a decrease in LOS was not observed in all participating hospitals. This is in contrast to the results presented by Larson et al [25] that focused on the collaborative implementation of a colorectal cancer CP in which reductions in LOS were achieved by all participating teams. A possible explanation for this discrepancy could be that the focus of our study was protocol adherence, as opposed to LOS.…”

Section: Resultscontrasting

confidence: 99%

“…The level of experience and support for using CP methodology provided to the improvement team appears to be directly related to the IR. This result is consistent with findings reported in previously published studies for colorectal surgery [1,8,11,25,28] as well as in other settings [29,30]. High IRs were achieved in hospitals in which a trained facilitator or quality management officer provided support for the improvement team.…”

Section: Implementation Processsupporting

confidence: 91%

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: Resultscontrasting

confidence: 99%

Section: Implementation Processsupporting

confidence: 91%

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

“…Demographic information and surgical details were retrieved in line with previously and extensively described methodology. High overall compliance with the pathway had been documented previously by both institutions.…”

Section: Methodsmentioning

confidence: 99%

Identification of patients eligible for discharge within 48 h of colorectal resection

Grass

Mathis

Hahnloser

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background This study aimed to identify patients eligible for a 48‐h stay after colorectal resection, to provide guidance for early discharge planning. Methods A bi‐institutional retrospective cohort study was undertaken of consecutive patients undergoing major elective colorectal resection for benign or malignant pathology within a comprehensive enhanced recovery pathway between 2011 and 2017. Overall and severe (Clavien–Dindo grade IIIb or above) postoperative complication and readmission rates were compared between patients who were discharged within 48 h and those who had hospital stay of 48 h or more. Multinominal logistic regression analysis was performed to ascertain significant factors associated with a short hospital stay (less than 48 h). Results In total, 686 of 5122 patients (13·4 per cent) were discharged within 48 h. Independent factors favouring a short hospital stay were age below 60 years (odds ratio (OR) 1·34; P = 0·002), ASA grade less than III (OR 1·42; P = 0·003), restrictive fluid management (less than 3000 ml on day of surgery: OR 1·46; P < 0·001), duration of surgery less than 180 min (OR 1·89; P < 0·001), minimally invasive approach (OR 1·92; P < 0·001) and wound contamination grade below III (OR 4·50; P < 0·001), whereas cancer diagnosis (OR 0·55; P < 0·001) and malnutrition (BMI below 18 kg/m2: OR 0·42; P = 0·008) decreased the likelihood of early discharge. Patients with a 48‐h stay had fewer overall (10·8 per cent versus 30·6 per cent in those with a longer stay; P < 0·001) and fewer severe (2·6 versus 10·2 per cent respectively; P < 0·001) complications, and a lower readmission rate (9·0 versus 11·8 per cent; P = 0·035). Conclusion Early discharge of selected patients is safe and does not increase postoperative morbidity or readmission rates. In these patients, outpatient colorectal surgery should be feasible on a large scale with logistical optimization.

show abstract

“…The PCPh can encourage the surgical team to initiate a diet the night of surgery instead of on the first postoperative day to facilitate earlier resumption of home medications and, potentially, earlier hospital discharge. Models like these have been determined transferable to other institutions as shown in a recent collaborative example for colorectal surgery and in the goals for the American College of Surgeons, which include improvement in patient experience, teamwork, and safety culture as well as reductions in opioid use, hospital‐acquired infections, and venous thromboembolic events …”

Section: Enhanced Recovery Pathways and The Role Of The Perioperativementioning

confidence: 99%

“…Evolving literature exists to support expanded clinical pharmacist presence in surgical patient care. PCPh practice has been described in a variety of roles including, but not limited to, enhanced recovery program (ERP) development and implementation, collaborative practice agreements, preoperative antimicrobial prophylaxis, venous thromboembolism risk assessment and prophylaxis, postoperative nausea and vomiting (PONV) prevention, pain management, and glycemic control . Several studies have identified clinical pharmacist practices that led to improved safety outcomes in perioperative patients.…”

Section: Improving Outcomes Across the Surgical Continuum Of Care: Scmentioning

confidence: 99%

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

Patel

Hyland

Birrer

et al. 2019

J Am Coll Clin Pharm

Self Cite

View full text Add to dashboard Cite

Current published guidelines for perioperative pharmacy services have limited information on the development and implementation of a robust clinical pharmacy program across the surgical continuum of care. This publication defines the responsibilities and scope of practice of the Perioperative Clinical Pharmacist (PCPh), supporting the PCPh as a critical member of the interprofessional surgical patient care team. Opportunities for pharmacist role integration into perioperative medication management processes are described along with published examples of successful PCPh practice models, including those with interventions targeted toward Enhanced Recovery Pathways (ERP). Recommended training and competencies for future and practicing perioperative pharmacists, in addition to considerations for precepting and scholarly activities, are also outlined. Finally, future developments in perioperative pharmacy practice are discussed, including technological advancements, improved predictive models, and expansion of collaborative practice agreements.

show abstract

A Collaborative for Implementation of an Evidence-Based Clinical Pathway for Enhanced Recovery in Colon and Rectal Surgery in an Affiliated Network of Healthcare Organizations

Cited by 11 publications

References 8 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

Identification of patients eligible for discharge within 48 h of colorectal resection

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

Contact Info

Product

Resources

About