Standardization of clinical care pathway leads to sustained decreased length of stay following Nuss pectus repair: A multidisciplinary quality improvement initiative

Gurria, Juan P.; Simpson, Blair; Tuncel-Kara, Setenay; Bates, Christina; McKenna, Emily; Rogers, Tracy L.; Kraemer, Aimee; Platt, Michael; Mecoli, Marc; Garcia, Victor F.; Brown, Rebeccah L.

doi:10.1016/j.jpedsurg.2020.08.009

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…A comprehensive literature search was conducted using CINAHL and MEDLINE (ProQuest) to identify research studies from the past 5 years that evaluated nurses' knowledge of postoperative care for patients undergoing chest wall corrective surgery. Six studies (AlReshidi et al, 2018; Guria et al, 2020; Litz et al, 2017; Puett & Smith, 2018; Smeland et al, 2018; Wharton et al, 2020) were identified that investigated nurses' knowledge and attitudes of postoperative pain management in the pediatric patient and the effectiveness of enhanced recovery pathways to improve patient outcomes.…”

Section: Methodsmentioning

confidence: 99%

Caring for the Pediatric Patient Post-Nuss Procedure

Duque

Sarik

Buscemi

et al. 2023

Journal of Pediatric Surgical Nursing

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BackgroundSurgical correction for pectus excavatum (PE) is often performed during adolescence for patients exhibiting cardiac and respiratory problems. The surgery to correct PE is a thoracoscopic-assisted minimally invasive repair of PE or Nuss procedure. The postoperative clinical management is largely related to addressing pain from the constant pressure from the bar(s) on the sternum. A quality improvement project was developed to improve nurses' knowledge of appropriate postoperative care for the pediatric patient undergoing a Nuss procedure.MethodA literature search was conducted using CINAHL and MEDLINE (ProQuest) to identify research studies that have evaluated nurses' knowledge of postoperative care for patients undergoing surgical correction for PE. Six studies were identified that investigated nurses' knowledge and attitudes of postoperative pain management in the pediatric patient and the effectiveness of enhanced recovery pathways to improve patient outcomes. A pretest and posttest were developed from the findings of the literature review along with an educational intervention. The educational presentation focused on the postoperative care of the pediatric patient who undergoes a Nuss procedure. A complete supplemental care plan is provided, which includes an enhanced recovery after surgery pathway, recommended pain treatment plan, exercises, medication recording sheet, home management tips for pain control, and patient discharge information.ResultsImplementation of a targeted educational program for the care of the pediatric patient who undergoes a Nuss procedure improved the clinician's knowledge and attitudes, resulting in a positive impact on pain management practice and patient outcomes.ConclusionTargeted educational interventions to improve pain management knowledge in nurses can result in increased understanding of appropriate postoperative pain management. This increased knowledge has the possibility to improve pain management and significantly improve the nurse and patient experience.

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Section: Methodsmentioning

confidence: 99%

Caring for the Pediatric Patient Post-Nuss Procedure

Duque

Sarik

Buscemi

et al. 2023

Journal of Pediatric Surgical Nursing

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“…Nuss procedure for correction of pectus excavatum is associated with severe postoperative pain. With our prior thoracic epidural catheter-based pain protocol, length of stay (LOS) was 3.4 days and 30-day emergency department (ED) visit/readmission rates were 3.7%/1.3%, respectively 1. Because pain management during the transition from epidural to oral medications was challenging, we adopted a multimodal ambulatory erector spinae (ESP) catheter protocol in March 2020.…”

Section: Introductionmentioning

confidence: 99%

Multimodal continuous ambulatory erector spinae catheter pain protocol for early recovery following Nuss procedure: a retrospective cohort study

Abbasian

Clay

Batra

et al. 2022

Reg Anesth Pain Med

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“…[4][5][6] They have been found to improve timeliness and quality of care in other populations and are becoming more accepted in the field of paediatric cardiac surgery. 7,8 Care pathways provide clear expectations of care, a means of measuring patient progress, and promote multi-disciplinary teamwork. Clinical pathways also reduce health care related mortality and morbidity and their respective costs.…”

mentioning

confidence: 99%

Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

et al. 2021

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Every year in Australia over a thousand children who are born with congenital heart disease require surgical intervention. Vocal cord dysfunction (VCD) can be an unavoidable and potentially devastating complication of surgery for congenital heart disease. Structured, multidisciplinary care pathways help to guide clinical care and reduce mortality and morbidity. An implementation study was conducted to embed a novel, multidisciplinary management pathway into practice using the consolidated framework for implementation research (CFIR). The goal of the pathway was to prepare children with postoperative vocal cord dysfunction to safely commence and transition to oral feeding. Education sessions to support pathway rollout were completed with clinical stakeholders. Other implementation strategies used included adaptation of the pre-procedural pathway to obtain consent, improving the process of identifying patients on the VCD pathway, and nominating a small team who were responsible for the ongoing monitoring of patients following recruitment. Implementation success was evaluated according to compliance with pathway defined management. Our study found that while there were several barriers to pathway adoption, implementation of the pathway was feasible despite pathway adaptations that were required in response to COVID-19.

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Standardization of clinical care pathway leads to sustained decreased length of stay following Nuss pectus repair: A multidisciplinary quality improvement initiative

Cited by 8 publications

References 26 publications

Caring for the Pediatric Patient Post-Nuss Procedure

Caring for the Pediatric Patient Post-Nuss Procedure

Multimodal continuous ambulatory erector spinae catheter pain protocol for early recovery following Nuss procedure: a retrospective cohort study

Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

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