A qualitative examination of barriers and facilitators of pediatric enhanced recovery protocol implementation among 18 pediatric surgery services.
A qualitative examination of barriers and facilitators of pediatric enhanced recovery protocol implementation among 18 pediatric surgery services.
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DOI：
10.1186/s43058-022-00329-8
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发表时间：
2022-08-18
影响因子：
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中科院分区：
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加速康复方案 (ERP) 是一种基于证据的干预措施，旨在优化术后康复。多项研究表明，胃肠道手术使用 ERP 可以缩短住院时间、缩短正常饮食的时间、减少阿片类药物的使用，同时还可以降低并发症和 30 天再入院率。然而，与成人手术相比，ERP 在儿科手术中的实施相对滞后。该研究的目的是对美国提供儿科手术服务的医院实施 ERP 的障碍和促进因素进行理论指导评估。我们在 18 家医院对 48 名参与者进行了半结构化访谈，其中包括儿科外科医生、麻醉师、胃肠病学家、护士和医师助理。访谈通过在线进行、录音并逐字转录。为了识别 ERP 实施的障碍和促进因素，我们使用基于五个主动实施框架 (AIF) 的演绎逻辑进行了分析。有效实践（可用的创新）因缺乏对 ERP 元素的合规性而受到挑战，而促进者则制定了标准化协议并为实施提供了组织支持。有效的实施（实施阶段和实施驱动因素）在从探索到全面实施的各个阶段都存在广泛的实施障碍。障碍包括需要专门的 ERP 实施团队以及医院领导层的支持。除了现场检查表、监督 ERP 实施的保护时间以及电子病历中内置的 ERP 元素的订单集之外，这些项目一旦存在，就可以有力地促进有效实施。赋能环境（团队）重点关注团队参与 ERP 实施以及他们如何协作实施 ERP。障碍包括手术团队成员抵制变革或不接受儿科实践中的 ERP。协调员包括让多学科团队参与进来，并在实施过程的早期让患者和家属参与进来。通过提供 ERP 实施指南、基于团队的变革管理支持以及建立 ERP 实施团队的协议，可以解决小儿外科实施 ERP 的障碍。未来的步骤是在阶梯式楔形、整群随机试验中应用和评估这些策略，以加强 ERP 在这 18 家医院的实施。
Enhanced recovery protocols (ERPs) are an evidence-based intervention to optimize post-surgical recovery. Several studies have demonstrated that the use of an ERP for gastrointestinal surgery results in decreased length of stay, shortened time to a regular diet, and fewer administered opioids, while also trending toward lower complication and 30-day readmission rates. Yet, implementation of ERPs in pediatric surgery is lagging compared to adult surgery. The study’s purpose was to conduct a theory-guided evaluation of barriers and facilitators to ERP implementation at US hospitals with a pediatric surgery service. We conducted semi-structured interviews at 18 hospitals with 48 participants, including pediatric surgeons, anesthesiologists, gastroenterologists, nurses, and physician assistants. Interviews were conducted online, audio-recorded, and transcribed verbatim. To identify barriers and facilitators to ERP implementation, we conducted an analysis using deductive logics based on the five Active Implementation Frameworks (AIFs). Effective practices (usable innovations) were challenged by a lack of compliance to ERP elements, and facilitators were having standardized protocols in place and organization support for implementation. Effective implementation (stages of implementation and implementation drivers) had widespread barriers to implementation across the stages from exploration to full implementation. Barriers included needing dedicated teams for ERP implementation and buy-in from hospital leadership. These items, when present, were strong facilitators of effective implementation, in addition to on-site, checklists, protected time to oversee ERP implementation, and order sets for ERP elements built into the electronic medical record. The enabling context (teams) focused on teams’ engagement in ERP implementation and how they collaborated to implement ERPs. Barriers included having surgical team members resistant to change or who were not bought into ERPs in pediatric practice. Facilitators included engaging a multi-disciplinary team and engaging patients and families early in the implementation process. Barriers to ERP implementation in pediatric surgery highlighted can be addressed through providing guidelines to ERP implementation, team-based support for change management, and protocols for developing an ERP implementation team. Future steps are to apply and evaluate these strategies in a stepped-wedge, cluster randomized trial to increase the implementation of ERPs at these 18 hospitals.
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使用定性和参与式方法来完善实施策略：儿科癌症中的普遍家庭社会心理筛查。
影响因子：
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作者：
Deatrick JA;Kazak AE;Madden RE;McDonnell GA;Okonak K;Scialla MA;Barakat LP
通讯作者：
Barakat LP
影响因子：
1.7
作者：
Heiss, Kurt F.;Raval, Mehul, V
通讯作者：
Raval, Mehul, V
影响因子：
7.2
作者：
Gramlich, Leah M.;Sheppard, Caroline E.;Nelson, Gregg
通讯作者：
Nelson, Gregg
DOI：
10.1136/bmjquality.u208370.w3387
发表时间：
2015-01-01
期刊：
BMJ quality improvement reports
影响因子：
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作者：
McDonald, Ruth
通讯作者：
McDonald, Ruth
影响因子：
5.7
作者：
Holt, Daniel T.;Helfrich, Christian D.;Weiner, Bryan J.
通讯作者：
Weiner, Bryan J.