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Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic

Lisa Pagano1, Oya Gumuskaya2,3,4, Janet C Long1

  • 1Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.

Journal of Advanced Nursing
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Summary

Local consensus discussions are key for implementing perioperative pathways in elective surgery. This systematic review identifies core elements and models for these discussions to reduce clinical variation.

Keywords:
consensusimplementation scienceimplementation strategyperioperative pathways

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Area of Science:

  • Healthcare Management
  • Surgical Pathway Implementation
  • Clinical Process Improvement

Background:

  • Unwarranted clinical variation in surgical care necessitates standardized perioperative pathways.
  • Local consensus discussions are frequently employed to facilitate pathway implementation.
  • Understanding the methodologies of these discussions is crucial for effective healthcare improvement.

Purpose of the Study:

  • To systematically review and understand diverse approaches to local consensus discussions.
  • To identify core elements and synthesize models for implementing perioperative pathways for common elective surgeries.

Main Methods:

  • Systematic review of literature published between January 2000 and April 2023.
  • Searched five major databases (MEDLINE, CINAHL, EMBASE, Web of Science, Cochrane Library).
  • Independent screening, quality assessment, data extraction, and narrative synthesis to develop process models.

Main Results:

  • 63 articles met inclusion criteria after reviewing 1159 initial records.
  • Reporting of local consensus discussions varied significantly.
  • Identified four consistently reported elements defining a structured process for consensus discussions.

Conclusions:

  • Local consensus discussions are a common strategy to minimize unwarranted variation in surgical care.
  • Several models for conducting and implementing consensus discussions are presented.
  • Refining reporting standards and advocating for systematic approaches can enhance consensus-building in perioperative pathway development.