Putting guidelines into practice: a tailored multi-modal approach to improve post-operative assessments

Area of Science:

• Medical Auditing
• Surgical Care Improvement
• Healthcare Quality Management

Background:

• The Scottish Intercollegiate Guideline Network (SIGN) guidelines advocate for optimized post-operative care through assessments.
• The study aimed to enhance post-operative assessments within a surgical high-dependency unit (HDU).

Purpose of the Study:

• To improve the quality and timeliness of post-operative assessments in a surgical HDU.
• To implement and evaluate a tailored multi-modal intervention to address barriers in post-operative care.

Main Methods:

• A prospective audit of post-operative admissions to a surgical HDU was conducted over two 4-week periods.
• A multi-modal intervention including staff education, designated HDU bleeps, and a standardized assessment pro forma was implemented.
• A re-audit was performed after 6 months to assess the impact of the intervention.

Main Results:

• The time to post-operative assessment significantly improved, with 74% of patients assessed within 4 hours post-intervention compared to 37% previously.
• Individual patient reviews increased from 21% to 61%, while reviews due to nursing concerns decreased from 32% to 2%.
• Documentation of key patient information, including medical history, medications, allergies, and complications, showed substantial improvement (e.g., past medical history from 3% to 29%).

Conclusions:

• A tailored multi-modal approach effectively improved clinical practice in post-operative assessments.
• Staff education, enhanced communication, and improved documentation led to significant positive changes.
• Despite improvements, further enhancements are necessary to achieve optimal best practice standards in post-operative care.