The creation of a pediatric surgical checklist for adult providers.

PURPOSE: To address the need for a pediatric surgical checklist for adult providers. BACKGROUND: Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications. METHODS: Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2023 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias. RESULTS: Forty-two papers with 8,529,061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies. CONCLUSION: The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes. FUNDING: Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540.

Current Advances in Patient-Perceived Quality Assessment Within Romanian Healthcare.

The global healthcare landscape is shifting toward patient-centered care, emphasizing the integration of patient feedback into service delivery. Romania, aligning with this trend, has implemented patient-perceived quality assessment tools to enhance healthcare services and better meet patient needs and expectations. This study aims to review comprehensively the implementation and impact of these tools in Romania, focusing on their role in improving healthcare quality. By examining key assessment instruments such as the Patient Satisfaction Questionnaire (PSQ), the Service Quality (SERVQUAL) model, and the Romanian Healthcare Quality Assessment Survey (RHQAS), the research seeks to understand how these tools have been used to identify areas for improvement and drive advancements in patient care. Employing a comprehensive review methodology, the study will conduct a thorough literature search to identify relevant studies, reports, and publications, analyzing the PSQ, SERVQUAL, and RHQAS in detail to understand their measurement domains, psychometric properties, and application within Romania. Additionally, qualitative data from interviews with healthcare providers and patients may be collected to offer further insights into the use and effectiveness of these tools. The study's findings are expected to provide valuable insights into the role of patient-perceived quality assessment tools in enhancing healthcare in Romania, identifying strengths, weaknesses, and opportunities for improvement. The results will highlight the effectiveness of combining international methodologies with localized adaptations to address the specific needs of the Romanian healthcare system, ultimately contributing to the ongoing efforts to improve patient satisfaction and health outcomes by informing the development and refinement of patient-centered care initiatives in Romania.

What Matters to Patients on the Day of Surgery-A Flash Mob Study.

PURPOSE: To explore what matters to patients on the day of surgery, to describe how a flash mob study was conducted in a perioperative setting and to provide recommendations for future studies adopting the flash mob design. DESIGN: Flash mob study. METHODS: On June 6 to June 7, 2023, a 24-hour flash mob study was carried out in eight Danish perioperative units. Eligible for inclusion were adult patients scheduled for elective or acute surgery. After giving informed consent, patients answered two qualitative questions: what mattered to them on the day of surgery, and whether the staff were aware of this. Data were analyzed using content analysis. Patient characteristics were presented using descriptive statistics. FINDINGS: Patients expressed a need to feel safe and cared for, be informed, and to receive proper anesthesia and postoperative care. Twenty-nine percent had not told health care staff, most often because they had not been asked about what mattered to them and because they did not want to be a nuisance. CONCLUSIONS: The flash mob study was feasible and provided insight into patients' perspectives on the day of surgery. To gain insight into what matters on the day of surgery, health care professionals must actively ask patients. Furthermore, the flash mob proved to be an opportunity to create attention to what matters to patients on the day of surgery.

Exploring Heart Rate Variability Biofeedback as a Nonpharmacological Intervention for Enhancing Perioperative Care: A Narrative Review.

Heart rate variability biofeedback (HRVBF) is a non-invasive therapeutic technique that aims to regulate variability in heart rate. This intervention has promise in mitigating perioperative stress, a critical factor for surgical patient outcomes. This comprehensive review aimed to explore the current evidence on the perioperative role of HRV biofeedback in improving patient outcomes, reducing perioperative stress, enhancing recovery, and optimizing anaesthesia management. A review of the PubMed and Google Scholar databases was conducted to identify articles focused on HRVBF in relation to the perioperative period. Studies were selected using appropriate keywords in English (MeSH). Ample potential applications of HRVBF in clinical anaesthesia have been identified and proven feasible. It is a non-invasive and an easy method an anaesthesiologists has at its disposal with potential utility in reducing perioperative stress, as a tool of optimization of comorbidities, analgesia supplementation and in predicting catastrophic complications. Although HRVBF has the potential to enhance anaesthesia management and improve patient outcomes, several limitations and challenges must be addressed to maximize its clinical utility. Overcoming these obstacles through research and technological advancements will be crucial for realizing the full benefits of HRVBF in perioperative care.

Evaluating ChatGPT as a Patient Resource for Frequently Asked Questions about Lung Cancer Surgery - A Pilot Study.

OBJECTIVE: Chat-based artificial intelligence (AI) programs like ChatGPT are re-imagining how patients seek information. This study aims to evaluate the quality and accuracy of ChatGPT-generated answers to common patient questions about lung cancer surgery. METHODS: A 30-question survey of patient questions about lung cancer surgery was posed to ChatGPT in July 2023. The ChatGPT-generated responses were presented to nine thoracic surgeons at four academic institutions who rated the quality of the answer on a 5-point Likert scale. They also evaluated if the response contained any inaccuracies and were prompted to submit free text comments. Responses were analyzed in aggregate. RESULTS: For ChatGPT-generated answers, the average quality ranged from 3.1-4.2 out of 5.0, indicating they were generally "good" or "very good". No answer received a unanimous 1-star (poor quality) or 5-star (excellent quality) score. Minor inaccuracies were found by at least one surgeon in 100% of the answers, and major inaccuracies were found in 36.6%. Regarding ChatGPT, 66.7% of surgeons felt it was an accurate source of information for patients. However, only 55.6% felt they were comparable to answers given by experienced thoracic surgeons, and only 44.4% would recommend it to their patients. Common criticisms of ChatGPT-generated answers included lengthiness, lack of specificity regarding surgical care, and lack of references. CONCLUSIONS: Chat-based AI programs have potential to become a useful information tool for lung cancer surgery patients. However, the quality and accuracy of ChatGPT-generated answers need improvement before thoracic surgeons could consider this method as a primary education source for patients.

Lived experience of burnout and fatigue in perioperative healthcare professionals in Rwanda: a qualitative study.

BACKGROUND: There is a lack of qualitative data on the negative effects of workplace stressors on the well-being of healthcare professionals in hospitals in Africa. It is unclear how well research methods developed for high-income country contexts apply to different cultural, social, and economic contexts in the global south. METHODS: We conducted a qualitative interview-based study including 64 perioperative healthcare professionals across all provinces of Rwanda. We used an iterative thematic analysis and aimed to explore the lived experience of Rwandan healthcare professionals and to consider to what extent the Maslach model aligns with these experiences. RESULTS: We found mixed responses of the effects on individuals, including the denial of burnout and fatigue to the points of physical exhaustion. Responses aligned with Maslach's three-factor model of emotional exhaustion, decreased personal accomplishment, and depersonalisation, with downstream effects on the healthcare system. Other factors included strongly patriotic culture, goals framed by narratives of Rwanda's recovery after the genocide, and personal and collective investment in developing the Rwandan healthcare system. CONCLUSIONS: The Rwandan healthcare system presents many challenges which can become profoundly stressful for the workforce. Consideration of reduced personal and collective accomplishment, of moral injury, and its diverse downstream effects on the whole healthcare system may better represent the costs of burnout Rwanda. It is likely that improving the causes of work-based stress will require a significant investment in improving staffing and working conditions.

Impact of Prewarming on Maintaining Perioperative Body Temperature: A Randomized Clinical Trial.

PURPOSE: To determine the prewarming effect on body temperature in the perioperative period of patients undergoing conventional abdominal surgery and the level of thermal comfort. DESIGN: A randomized controlled clinical trial. METHODS: A Brazilian oncology hospital located in São Paulo. A total of 99 patients aged 18 years or over undergoing elective conventional abdominal surgeries, with a minimum duration of 1 hour of anesthesia. The study was carried out from 2019 to 2021. Patients were randomized into 3 groups: prewarming with a blanket and cotton sheet (control; n = 33); prewarming with a forced-air warming system for 20 minutes (intervention 1; n = 33); prewarming with a forced-air warming system for 30 minutes (intervention 2; n = 33). Central temperature was measured by a zero-heat-flux temperature sensor every 20 minutes from the preoperative period until the surgery end time. The level of thermal comfort was determined through self-report during the preanesthetic and postanesthetic periods. FINDINGS: There was a significant difference between the temperatures between the groups (P = .048), with evidence of greater benefit in maintaining the temperature in the group that received the prewarming intervention for 20 minutes. There was no significant difference between the percentage of temperatures below 36 °C among the groups (P = .135). Patients in the intervention groups were more comfortable during the postanesthetic recovery period than those in the control group (P = .048). Only 7 (8.24%) patients had postoperative chills (P = .399) and more than half of these incidents occurred in the control group (4; 13.3%). CONCLUSIONS: Prewarming for 20 minutes obtained the best results, showing the lowest average of temperature episodes below 36 °C during the intraoperative period and greater thermal comfort as reported by patients.

Association Between English Proficiency and Postoperative Pain Management for Adult Patients Undergoing Gynecologic Surgery: A Retrospective Cohort Study.

PURPOSE: To determine if language-based disparities in postoperative pain management exist in women undergoing gynecologic surgery. DESIGN: A retrospective cohort study was performed. METHODS: The electronic medical records were reviewed of individuals, aged 18 to 80, who underwent an abdominal hysterectomy between 2016 and 2021 at the University of Colorado Anschutz Medical Center. A random sample of 100 patients, 50 categorized as English proficient and 50 categorized as having limited English proficiency (LEP), were compared. The primary outcomes were the number of quantitative pain assessments and the total dose of opioid given in oral morphine milligram equivalents. The secondary outcomes were the average pain scores, the number of qualitative pain assessments, postanesthesia care unit length of stay, regional block use, patient-controlled analgesia, or opioid use after the first 24 hours. Linear and generalized linear modeling was used to assess the relationship between English proficiency and the outcomes of interest. FINDINGS: All patients received at least 1 pain assessment while in the postanesthesia care unit (range 2 to 25). There was no significant difference in the number of objective pain assessments or the total dose of opioid given between the groups. There were no significant differences in any of the secondary outcomes between the groups. On subgroup analysis, the presence of a documented bedside interpreter did not result in a significant difference in endpoints. Fewer LEP patients received patient-controlled analgesia (34% LEP vs 58% English proficient), though the difference did not reach statistical significance. CONCLUSIONS: Language barriers may complicate care and impact postoperative recovery. In our population of women in a high-volume, urban, level I, trauma center, there were no observed differences in postoperative pain management practices in patients with LEP compared with English-proficient patients. Standardized nursing protocols may contribute to more equitable care. Ongoing investigations in the identification and prevention of language-related disparities in perioperative care are warranted.

To be or not to be on: aspirin and coronary artery bypass graft surgery.

Aspirin's role in secondary prevention for patients with known coronary artery disease (CAD) is well established, validated by numerous landmark trials over the past several decades. However, its perioperative use in coronary artery bypass graft (CABG) surgery remains contentious due to the delicate balance between the risks of thrombosis and bleeding. While continuation of aspirin in patients undergoing CABG following acute coronary syndrome is widely supported due to the high risk of re-infarction, the evidence is less definitive for elective CABG procedures. The literature indicates a significant benefit of aspirin in reducing cardiovascular events in CAD patients, yet its impact on perioperative outcomes in CABG surgery is less clear. Some studies suggest increased bleeding risks without substantial improvement in cardiac outcomes. Specific to elective CABG, evidence is mixed, with some data indicating no significant difference in thrombotic or bleeding complications whether aspirin is continued or withheld preoperatively. Advancements in pharmacological therapies and perioperative care have evolved significantly since the initial aspirin trials, raising questions about the contemporary relevance of earlier findings. Individualized patient assessments and the development of risk stratification tools are needed to optimize perioperative aspirin use in CABG surgery. Further research is essential to establish clearer guidelines and improve patient outcomes. The objective of this review is to critically evaluate the existing evidence into the optimal management of perioperative aspirin in elective CABG patients.

Enhanced Recovery After Surgery (ERAS) Practices in Minimally Invasive Gynaecologic Surgery: A National Survey.

OBJECTIVE: Enhanced recovery after surgery (ERAS) pathways are evidence-based practices that minimize perioperative physiologic stress, reducing postoperative complications and recovery time. This study assessed the Canadian application of, and adherence to, ERAS recommendations during minimally invasive gynaecologic surgery, and identified barriers to ERAS uptake. METHODS: A self-administered cross-sectional survey was distributed to obstetrics and gynaecology residents, fellows, and attendings through three national listservs from February 2021 to January 2022. The survey assessed 14 perioperative components per the AAGL (American Association of Gynecologic Laparoscopists) ERAS consensus guidelines. Two study groups were defined-participants with vs. without an established ERAS program-and comparison analyses as well as inferential statistical tests were performed. RESULTS: 158 responses were analyzed. 41.9% of respondents work in a centre with an ERAS program. Adherence to ERAS recommendations was high with engaging patients in the operative processes, changing equipment after a contaminated procedure, discontinuing urinary catheters, and initiating early postoperative mobilization. ERAS programing enhanced adherence to preoperative carbohydrate loading, intraoperative fluid management, normothermia, and bowel regimen adjuncts (P < 0.05). Despite ERAS programming, adherence to some recommendations-preoperative fasting, comorbidity optimisation-remained low. Most respondents felt that ERAS is safe (98%) and improves outcomes (82%). CONCLUSION: While the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners across Canada engage in various ERAS components. ERAS program sites had higher adherence to some perioperative recommendations; however, some high-level evidence recommendations still have national adherence gaps. Targeted research around low-adherence components would help identify and address barriers to optimize surgical care.

Assessment of Perioperative Protamine Reactions in Patients With Fish Allergies: A Retrospective Observational Study.

OBJECTIVES: To retrospectively assess the incidence and severity of perioperative protamine reactions in adult patients with documented history of fish allergy. DESIGN: Retrospective observational study. SETTING: Large academic tertiary referral center. PARTICIPANTS: Adults with fish allergies undergoing surgeries involving protamine, between January 1, 2008, and March 1, 2018. INTERVENTIONS: Perioperative protamine administration in patients with documented fish allergy. MEASUREMENTS AND MAIN RESULTS: Perioperative protamine and anaphylactic reactions were reviewed. A diagnosis of anaphylaxis or protamine reaction was based on clinical suspicion, perioperative events, and postoperative evaluations. Among 214 patients, 2 cases (<1%) of anaphylaxis or protamine reactions occurred. Cardiac procedures were most common (67%). The median intraoperative heparin dosage was 46,000 IU, and the median protamine dosage was 310 mg. Nearly all patients (99%) were admitted to the intensive care unit postoperatively, with a median hospital stay of 6.5 days (interquartile range, 5.2-14.6 days). There were 3 deaths (1%) within 30 days, and 15 (7%) within 1 year. CONCLUSIONS: The study findings suggest that in patients with a history of fish allergy, cross-reactivity with protamine is unlikely, as anaphylaxis and/or protamine reactions were rare in this patient population in the perioperative environment. Based on these findings, this study does not recommend avoiding protamine solely based on a history of fish allergy when heparin reversal is required during surgery.

Airway management in a child with complete tracheal transection following blunt laryngotracheal trauma.

Blunt injury to the neck following high-impact trauma can be associated with airway injury. The anaesthesiologist should have a high index of suspicion for the same when the patient presents for any surgical intervention for trauma. A complete evaluation of the tracheobronchial tree using a flexible bronchoscope is essential before instrumenting the airway in a child with suspected laryngotracheal trauma because blind intubation can convert a lesser grade airway trauma into a significant one. We report the airway management in a child belonging to middle childhood, who presented with complete tracheal transection after a blunt laryngotracheal trauma.

Frailty Is Associated With Increased Care Dependence in Patients Following Major Vascular Surgery.

OBJECTIVE: To assess if frailty scoring can predict increased frailty and care dependence requiring a change in living situation in patients with peripheral artery disease (PAD) following major vascular surgery. DESIGN: A single center, retrospective cohort study. SETTING: Fiona Stanley Hospital, a tertiary center located in Perth, Western Australia. PARTICIPANTS: Seventy-nine patients with PAD who underwent major vascular surgery at the study hospital in 2022 were enrolled. INTERVENTION: Baseline Clinical Frailty Scale (CFS) scores were assigned retrospectively. A quantitative analysis using two partitions, CFS 1-3 (not frail) versus 4-9 (frail) was used. Cases were screened for hospital-acquired complications, and records were reviewed to assess the level of care dependence at the time of discharge and 6 months following. MEASUREMENTS AND MAIN RESULTS: The primary outcome was to assess if frailty predicts increased care dependence. Secondary outcomes included unplanned readmissions and hospital-acquired complications in this cohort. A logistic regression was performed to predict the effects of age and baseline, discharge, and 6-month CFS on the likelihood of change in living situation. Baseline frailty was associated with a higher frailty score at discharge (p = 0.001), which persisted at 6 months (p = 0.001). There was no difference in American Society of Anesthesiologists classification, sex, age, 30-day mortality, or in-hospital complications between groups. After correcting for age, a lower baseline CFS (odds ratio 0.19, confidence interval 0.04-0.84, p = 0.028) and discharge CFS (odds ratio 34.00, confidence interval 3.88-298.42, p = 0.001) predicts the likelihood of patients having a change in living situation after surgery. CONCLUSIONS: Frail patients with PAD undergoing major vascular surgery are at significant risk of functional decline, necessitating a change in living situation to meet their increased care needs. This increased care dependence persisted 6 months following discharge.

Preoperative frailty and postoperative complications after non-cardiac surgery: a systematic review.

OBJECTIVE: Many tools have been used to assess frailty in the perioperative setting. However, no single scale has been shown to be the most effective in predicting postoperative complications. We evaluated the relationship between several frailty scales and the occurrence of complications following different non-cardiac surgeries. METHODS: This systematic review was registered in PROSPERO (CRD42023473401). The search strategy included PubMed, Google Scholar, and Embase, covering manuscripts published from January 2000 to July 2023. We included prospective and retrospective studies that evaluated frailty using specific scales and tracked patients postoperatively. Studies on cardiac, neurosurgical, and thoracic surgery were excluded because of the impact of underlying diseases on patients' functional status. Narrative reviews, conference abstracts, and articles lacking a comprehensive definition of frailty were excluded. RESULTS: Of the 2204 articles identified, 145 were included in the review: 7 on non-cardiac surgery, 36 on general and digestive surgery, 19 on urology, 22 on vascular surgery, 36 on spinal surgery, and 25 on orthopedic/trauma surgery. The reviewed manuscripts confirmed that various frailty scales had been used to predict postoperative complications, mortality, and hospital stay across these surgical disciplines. CONCLUSION: Despite differences among surgical populations, preoperative frailty assessment consistently predicts postoperative outcomes in non-cardiac surgeries.

Clinician perspectives on the perioperative roles and responsibilities of anesthesia, surgery, and primary care.

BACKGROUND: Although high-risk older patients benefit from a multidisciplinary approach to perioperative care, the specific roles and responsibilities of the clinicians involved have yet to be adequately characterized. METHODS: Qualitative analysis of semi-structured interviews with four anesthesia preoperative clinic providers, seven surgeons, and nine primary care providers in northern New England. RESULTS: The analysis revealed both distinct and overlapping roles and responsibilities. Anesthesia providers were described as a "safety net" and surgeons as "captain of the ship", in charge of getting "all the ducks in a row" to avoid surgery delays and cancellations. Primary care providers saw themselves as the "quarterback", ensuring care continuity and consideration of patient psychosocial factors. CONCLUSIONS: While all have a shared responsibility for facilitating patient-centered decision-making and a safe perioperative course, each discipline has different areas of focus and expertise. Role clarification can help optimize the distribution of responsibilities and enhance perioperative communication and collaboration.

Anesthesia Management in Antenatal Care for Women With Chronic Kidney Disease: A Comprehensive Review.

Chronic kidney disease (CKD) presents significant challenges in the management of pregnant women due to its impact on renal function and cardiovascular stability. This review examines the crucial role of anesthesia management in antenatal care for women with CKD, focusing on the complexities introduced by renal dysfunction and the implications for maternal and fetal health outcomes. The review discusses the physiological changes in CKD during pregnancy, highlighting the increased risks of hypertension, proteinuria, and adverse fetal outcomes. Anesthesia considerations, including the choice of anesthesia techniques (general anesthesia, regional anesthesia), perioperative monitoring, and management of fluid and electrolyte balance, are analyzed in the context of CKD-specific challenges. Clinical outcomes and current evidence regarding anesthesia efficacy and safety in CKD patients are reviewed, emphasizing the need for tailored anesthesia protocols to ensure optimal maternal comfort and fetal safety. The review concludes by identifying research gaps and proposing future directions to enhance anesthesia practices and improve outcomes for pregnant women with CKD undergoing surgical interventions or labor management.

Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy.

Background: With significant advancements in fetal cardiac imaging, patients with complex congenital heart disease (CHD) carrying a high risk for postnatal demise are now being diagnosed earlier. We sought to assess an interdisciplinary strategy for delivering these children in an operating room (OR) adjacent to a cardiac OR for immediate surgery or stabilization. Methods: All children prenatally diagnosed with CHD at risk for immediate postnatal hemodynamic instability and cardiogenic shock who were delivered in the operating room (OR) between 2012 and 2023 in which the senior author was consulted were included. Results: Eight patients were identified. Six (75%) patients were operated on day-of-life zero, all requiring obstructed total anomalous pulmonary venous return (TAPVR) repair. Of these six patients, 2 (33%) required a simultaneous Norwood procedure, 2 (33%) required pulmonary artery unifocalization and modified Blalock-Taussig-Thomas shunt, and 2 (33%) patients had repair of obstructed mixed TAPVR. The remaining 2 patients potentially planned for immediate surgery had nonimmune hydrops fetalis and went into cardiogenic shock at 12 and 72 hours postnatally, requiring a novel Norwood procedure with left-ventricular exclusion for severe aortic/mitral valve insufficiency. The median ventilation and inpatient durations were 19 [IQR: 11-26] days and 41 [IQR: 32-128] days, respectively. Three(38%) patients required one or more in-hospital reoperations. Subsequent staged procedures included Glenn (n = 5), Fontan (n = 3), biventricular repair (n = 2), ventricular assist device placement (n = 1), and heart transplant (n = 1). Median follow-up was 5.7 [IQR:1.3-7.8] years. The five-year postoperative survival was 88% (n = 7/8). Conclusion: While children with these diagnoses have historically had poor survival, the strategy of birth in the OR adjacent to a cardiac OR where emergent surgery is planned is a potentially promising strategy with excellent clinical outcomes. However, this is a high-resource strategy whose feasibility in any program requires thoughtful assessment.

Refining, implementing, and evaluating an anesthesia choice conversation aid for older adults with hip fracture: protocol for a stepped wedge cluster randomized trial.

BACKGROUND: Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counseling patients on anesthesia for this procedure. We designed an Option Grid™-style conversation aid, My Anesthesia Choice─Hip Fracture, to promote shared decision making in this interaction. This study will refine the aid and evaluate its implementation and effectiveness in clinical practice. METHODS: The study will be conducted over 2 phases: qualitative interviews with relevant clinicians and patients to refine the aid, followed by a stepped wedge cluster randomized trial of the intervention at 6 settings in the US. Primary outcomes will include the percentage of eligible patients who receive the intervention (intervention reach) and the change in quality of patient/clinician communication (intervention effectiveness). Secondary outcomes addressing other RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) domains will also be collected. Outcomes will be compared between baseline data and an active implementation period and then compared between the active implementation period and a sustainment period. Implementation strategies are guided by three constructs from the Practical, Robust Implementation and Sustainability Model (PRISM): intervention, recipients, and implementation and sustainability infrastructure. DISCUSSION: This is a novel, large-scale trial evaluating and implementing a shared decision-making conversation aid for anesthesia choices. Strong buy-in from site leads and expert advisors will support both the success of implementation and the future dissemination of results and the intervention. Results from this study will inform the broader implementation of this aid for patients with hip fractures and can lead to the development and implementation of similar conversation aids for other anesthesia choices. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06438640.