Prospective application of an implementation framework to improve postoperative nutrition care processes: Evaluation...

Area of Science:

• Healthcare Quality Improvement
• Implementation Science
• Geriatric Surgery

Background:

• Adherence to evidence-based postoperative diet guidelines, like Enhanced Recovery After Surgery (ERAS), is crucial for older surgical patients.
• Quality improvement (QI) projects require effective frameworks for planning and evaluation to succeed.
• Identifying barriers and facilitators is key to successful implementation of clinical practice changes.

Purpose of the Study:

• To prospectively apply an implementation framework to guide and evaluate a QI project.
• To improve adherence to ERAS-consistent postoperative diet guidelines in older surgical patients.
• To assess the impact of facilitated implementation strategies on clinical processes and outcomes.

Main Methods:

• A hybrid mixed methods study utilized the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.
• Pre-implementation audits identified care gaps; qualitative interviews explored barriers.
• A controlled before-after study evaluated implementation outcomes and clinical results post-intervention.

Main Results:

• The implementation framework guided 17 facilitation activities, leading to acceptable (89%) and well-adopted (79%) early postoperative diet upgrades.
• Fidelity was 59%, with challenges in diet coding impacting protocol adherence.
• Patients in the intervention group had significantly higher odds of receiving early nutrition post-implementation (aOR: 6.5 [1.9-22.4], P=0.01).

Conclusions:

• Prospective application of an implementation framework facilitated successful planning and execution of the QI project.
• Multi-level evaluation of facilitation, implementation outcomes, and clinical results provides insights into successes and challenges.
• The study highlights the utility of implementation science frameworks in improving geriatric surgical patient care pathways.