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Process measures facilitate maturation of pediatric enhanced recovery protocols

Ira L Leeds1, Mitchell R Ladd1, Margaret H Sundel1

  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Journal of Pediatric Surgery
|May 27, 2018
PubMed

Insights

Monitoring process measures in pediatric colorectal surgery enhanced recovery protocols is feasible. Adherence to these processes may reduce patient complications and improve quality of care.

Area of Science:

  • Pediatric Surgery
  • Quality Improvement
  • Enhanced Recovery Protocols

Background:

  • The predictive role of process measures for quality in pediatric colorectal surgery enhanced recovery protocols is not well-defined.
  • Enhanced recovery after surgery (ERAS) pathways aim to optimize surgical patient care.

Purpose of the Study:

  • To demonstrate the feasibility of abstracting and monitoring process measures within a pediatric colorectal surgery enhanced recovery protocol.
  • To assess the impact of protocol implementation stages on process measures and patient outcomes.

Main Methods:

  • A quality improvement database was utilized to track patients in the Pediatric Colorectal Enhanced Recovery After Surgery pathway.
  • Patients were grouped by implementation stage to compare process measures and 30-day outcomes.
  • Multistage enhanced recovery process measures were analyzed.

Main Results:

  • Of 58 surgical patients, 28 (48%) were enrolled in the pathway.
  • Increased use of regional anesthesia (83% vs. 20%) and improvements in preoperative education (56% vs. 0%) and medication administration were observed.
  • While overall complications were similar, readmissions were higher in the early implementation phase, and later implementation correlated with fewer complications.

Conclusions:

  • Process measures are valuable complements to outcome measures for assessing the quality and effectiveness of pediatric colorectal enhanced recovery protocols.
  • Adherence to established processes in enhanced recovery pathways shows potential for reducing postoperative complications.
Abstract

Keywords:
ChildColorectal surgeryEnhanced recovery after surgeryOutcome assessmentProcess assessmentQuality improvement

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