Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey
| Autor: | Dominique Fletcher, Nawal Derridj, Anissa Belbachir, Philippe Aegerter, Lionelle Nkam, Eva Battaglia, Hakim Harkouk, Perrine Capmas, Laure Tharel |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Hysterectomy Post-operative complications RD1-811 business.industry medicine.medical_treatment General surgery Research Total knee arthroplasty University hospital Chart Enhanced recovery Retrospective survey Medicine Length of stay Surgical Models Surgery business Colectomy |
| Zdroj: | Perioperative Medicine, Vol 10, Iss 1, Pp 1-10 (2021) Perioperative Medicine |
| ISSN: | 2047-0525 |
| Popis: | Background Enhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP). Methods A retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure. Results 1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items’ application when data collected in 2015 and 2017 were analysed together. Conclusion ERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|