Implementation of Enhanced Recovery Protocols for Gastrointestinal Surgery in Children: Practical Tools From Key Stakeholders.
Implementation of Enhanced Recovery Protocols for Gastrointestinal Surgery in Children: Practical Tools From Key Stakeholders.
复制标题
儿童胃肠手术加速康复方案的实施：来自主要利益相关者的实用工具。
DOI：
10.1016/j.jss.2022.11.071
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Raval,MehulV
中科院分区：
文献类型：
--
作者：
Close,Sharron;Blake,SarahC;Davis,TeanieseTina;Balbale,SalvaN;Perry,JosephE;Weingard,Reed;Ingram,Martha-Conley;Schäfer,Willemijn;Strople,Jennifer;Raval,MehulV
简介我们探讨了患者、护理人员和提供者的建议，以开发工具包，为接受胃肠手术的儿科患者实施加速康复方案 (ERP)。 ERP 广泛用于成人，以减少住院时间、住院费用和并发症，同时加快患者术后康复。由于儿科人群中 ERP 的可用数据有限，需要对成人 ERP 进行知情修改，以促进儿科手术的成功实施。方法采用定性研究设计，对包括外科医生、麻醉师、胃肠病学家、护理人员和医师助理在内的医院团队进行半结构化访谈。在两家儿科医院与患者和护理人员举行了四场现场焦点小组会议。开发了代码并将其应用于访谈和焦点小组的笔录，以进行结构内容分析。以主动实施框架为指导的主题分析包括为 ERP 实施工具包开发提供信息的建议。结果 ERP 工具包的关键组成部分包括对结构化和系统性方法的需求、主要支持者的领导支持以及手术合作伙伴和医院管理层的支持。提供商确定需要为员工和患者提供有关 ERP 要素的多模式教育材料；使用统一的清单、护理集和电子存储库来收集结果数据以进行质量保证评估。患者和护理人员支持扩大团队规模，纳入儿童生活专家、营养师和患者家长支持者，以帮助引导手术体验。结论这项研究是第一项利用患者、护理人员和提供者的关键意见来确定适用于接受胃肠手术的儿童的 ERP 实施工具包的实用组件的研究。
IntroductionWe explored patient, caregiver, and provider recommendations for development of a tool kit to implement enhanced recovery protocols (ERPs) for pediatric patients undergoing gastrointestinal surgery. ERPs are widely used for adults to decrease hospital length of stay, hospital costs, and complications while hastening patient recovery after surgery. With limited data available for ERPs among pediatric populations informed modification of adult ERPs is needed to facilitate successful implementation for pediatric surgery.MethodsUsing a qualitative research design, semistructured interviews were conducted with hospital-based teams including surgeons, anesthesiologists, gastroenterologists, nursing, and physician assistants. Four in-person focus groups were held at two pediatric hospitals with patients and caregivers. Codes were developed and applied to interview and focus groups transcripts for structural content analysis. Thematic analysis guided by the Active Implementation Framework, included recommendations that informed ERP implementation tool kit development.ResultsKey components of the ERP tool kit included the need for a structured and systematic approach, leadership support from key champions, and buy-in from surgical partners and hospital management. Providers identified the need for multimodal educational materials on ERP elements for staff and patients; use of uniform checklists, care sets and an electronic repository to collect outcome data for quality assurance assessment. Patients and caregivers endorsed expansion of the team to include child-life specialists, nutritionists, and patient-parent supporters to help navigate the surgical experience.ConclusionsThis study is the first to leverage key input from patients, caregivers, and providers to identify practical components for an ERP implementation tool kit for children undergoing gastrointestinal surgery.
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