Hepato - Pancreato -Biliary Surgery

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Hepato - Pancreato -Biliary Surgery. Developing a clinical pathway for patients undergoing pancreatic surgery. Whipple procedure. Pancreatic Surgery. complex abdominal surgery majority cases are performed for cancer strong correlation between volume of surgery and outcomes - PowerPoint PPT Presentation

Transcript of Hepato - Pancreato -Biliary Surgery

  • Hepato-Pancreato-Biliary SurgeryDeveloping a clinical pathway for patients undergoing pancreatic surgery

  • Pancreatic Surgerycomplex abdominal surgerymajority cases are performed for cancerstrong correlation between volume of surgery and outcomescases performed better outcomesCCO has designated high volume centre of excellences in Ontario

  • Study GoalImprove the quality of surgical care for patients undergoing pancreatic surgery in Ontario

  • Quality in healthcare

    Structures of CareCharacteristics of physicians and hospitalsContext in which care and services are provided

    Process of CareComponents of the encounter between a physician or another health care professional and patientssteps that occur during the actual delivery of care

    Outcomes of CareChanges in patients health status as a result of health care

  • structured multidisciplinary instrumentdetails the steps of care during a defined patient care episode critical pathwayclinical algorithmclinical protocol

    usually time dependent inventory of actionsused to standardize processes of care

    What is a Clinical Pathway?adapted from: Rotter T et al, Eval Health Prof, May 2011

  • Impact of clinical pathwaysImproved quality of carestandardization of processes of carereduced variabilityimproved efficiency high quality patient care documentation improved communication

    Good economic outcomes length of stay hospital costs

  • Impact of clinical pathwaysImproved patient outcomes length of stay patient morbidity and mortality in-hospital complications5.6% absolute risk reduction (n=5 trials)1Rotter T et al, Eval Health Prof, May 2011

  • Study QuestionCan we develop an evidence based clinical pathway for patients undergoing pancreatic surgery?

  • Identify current practices and tools being used at the high volume HPB sites in Ontario

    Prioritize and rank key elements of patient care that should be included in a pancreatic surgery pathway

    Identify barriers and enablers to will lead to successful and sustainable implementation of a clinical pathway

    Goals for this workshop

  • Summary of clinical pathway project

  • Walk us through a patient's journey through care after undergoing a Whipple at your hospital

  • How are you currently managing these patients?

  • How do team members communicate with one another?

  • How do you think we might use a clinical pathway?

  • Why do you think we might use a clinical pathway?

  • Prioritize and rank key elements of patient care that you feel should be included in a pancreatic surgery clinical pathwayProvide additional comments/ inputdoes pathway have face validity?are there missing items?do items that need clarification?multi-disciplinary clinical pathway mappre-printed MD orders

    Which elements should be included?

  • Multidisciplinary clinical pathway

    Pre-AdmissionOR DayPre-opOR DayPost-opPOD # 1POD # 2POD # 3 POD # 4,5,6Discharge DayDate:AssessmentsEducationObservationPain ManagementNutritionActivityDischargePlanningProceed/ Discontinue CP (Y/N)Physician Signature

  • Pre-printed MD orders

    Pre-Admission/ Pre-SurgicalOR DayPre-opOR DayPost-opPOD # 1POD # 2POD # 3 POD # 4,5,6POD # 6,7 Discharge dayDietActivityVitalsInvestigationsInterventionsDrugs

  • Benchmarking draft clinical pathway50 patient charts reviewed38 (76%) patients on pathwayAverage length of stay = 8.15 days12 (24%) patients went off pathwayAverage length of stay = 18.17 days

  • Benchmarking draft clinical pathwayhighest variability in postoperative nutrition, pain management and activity (ambulation

    elements most commonly missing patient education discharge planning

  • Wrap upplease hand in score sheetssign consent formsconsider joining the working group

    Thank you!

    *-multidisciplinary plan of best clinical practice*7 studies that measured complications reported results that favored CPWs. Six of the seven studies examined invasive conditions or interventions, for example, surgery procedures or mechanical ventilation. The pooled result of an absolute risk reduction of 5.6% (n 5 trials) for patients recovering from surgery, who were managed on a CPW corresponds to prevention of one complication for every 18 patients treated (NNT 18). This strongly suggests that CPWs have a substantial role to play in patient safety.

    Reduced variabilityImproved efficiency High quality patient care*7 studies that measured complications reported results that favored CPWs. Six of the seven studies examined invasive conditions or interventions, for example, surgery procedures or mechanical ventilation. The pooled result of an absolute risk reduction of 5.6% (n 5 trials) for patients recovering from surgery, who were managed on a CPW corresponds to prevention of one complication for every 18 patients treated (NNT 18). This strongly suggests that CPWs have a substantial role to play in patient safety.

    Reduced variabilityImproved efficiency High quality patient care*-variability in pain management = days when epidural or PCA is discontinued and when oral meds are started-postop nutrition = d/c NG, CF-DAT-activity also variation in the number of people being assessed for falls (Morse Fall scale) and those being seen by Physio.*-variability in pain management = days when epidural or PCA is discontinued and when oral meds are started-postop nutrition = d/c NG, CF-DAT-activity also variation in the number of people being assessed for falls (Morse Fall scale) and those being seen by Physio.*