Your browser doesn't support javascript.
loading
Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process.
Pilkington, Mercedes; Nelson, Gregg; Cauley, Christy; Holder, Kari; Ljungqvist, Olle; Molina, George; Oodit, Ravi; Brindle, Mary E.
Afiliación
  • Pilkington M; Formerly at Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
  • Nelson G; Department of Surgery, Division of Pediatric Surgery, University of Toronto, Toronto, Canada.
  • Cauley C; Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA.
  • Holder K; Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada.
  • Ljungqvist O; Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA.
  • Molina G; Alberta Health Services, Calgary, Canada.
  • Oodit R; School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
  • Brindle ME; Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA.
JAMA Netw Open ; 6(2): e2248460, 2023 02 01.
Article en En | MEDLINE | ID: mdl-36753283
ABSTRACT
Importance Enhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively.

Objective:

To integrate the 2 tools to facilitate key perioperative decision-making. Evidence Review Snowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022.

Findings:

Round 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs. Conclusions and Relevance The SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recuperación Mejorada Después de la Cirugía Tipo de estudio: Guideline / Prognostic_studies / Qualitative_research Límite: Female / Humans Idioma: En Revista: JAMA Netw Open Año: 2023 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recuperación Mejorada Después de la Cirugía Tipo de estudio: Guideline / Prognostic_studies / Qualitative_research Límite: Female / Humans Idioma: En Revista: JAMA Netw Open Año: 2023 Tipo del documento: Article País de afiliación: Canadá