The use of standardized order sets to improve adherence to evidence-based postoperative management in major head and neck surgery.
Eur Ann Otorhinolaryngol Head Neck Dis
; 135(5S): S107-S111, 2018 Sep.
Article
em En
| MEDLINE
| ID: mdl-30170974
ABSTRACT
BACKGROUND:
Standardized order sets (SOSs) are clinical tools derived from clinical care pathways that have shown improved patient-recovery and economic benefits. The primary objective was to examine the effect of SOSs on adherence to evidence-based postoperative guidelines for laryngectomy patients.METHODS:
A retrospective chart review comparing handwritten and SOS-based postoperative physician orders was conducted for consecutive laryngectomies performed (n=70) within a 3-year time period. Orders were analyzed for errors and deviations from evidence-based guidelines. Secondary outcome included complications such as thromboembolic disease, return to operating room, fistula formation, salivary bypass tube, length of hospital stay and death.RESULTS:
Approximately 81% of cases utilizing handwritten orders had at least one error (n=36) compared to 38% in the group that used an SOS (n=34) (P<0.0001). Subgroup analyses demonstrated that errors in mechanical deep vein thrombosis prophylaxis (P<0.0001) and antibiotic prophylaxis (P=0.0173) orders were significantly reduced in the SOS group compared to the handwritten group. No significant differences were observed between the two groups for measured postoperative complications (P>0.05) and length of hospital stay (18.6 days in both SOS and handwritten orders groups).CONCLUSIONS:
SOSs are associated with reduced errors in postoperative orders. They are important tools to improve adherence to standardized guidelines for surgeries requiring complex postoperative management. Clinical care pathways and Enhanced Recovery After Surgery protocols can use SOSs to ensure appropriate orders are being made.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Padrões de Prática Médica
/
Fidelidade a Diretrizes
/
Prática Clínica Baseada em Evidências
/
Laringectomia
Tipo de estudo:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Implementation_research
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Eur Ann Otorhinolaryngol Head Neck Dis
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Canadá