Implementation of Enhanced Recovery Protocols for GI Surgery in Children: Practical Tools from Key Stakeholders

• Type of Material: Article
• Authors: Sharron Close, Emory University; Sarah C. Blake, Emory University; Teaniese "Tina" Davis, Kaiser Permanente Georgia; Salva n. Balbale, Northwestern University; Joseph E. Perry, Emory University; Reed Weingard, Emory University; Martha-Conley Ingram, Northwestern University; Willemign Schäfer, Northwestern University; Jennifer Strople, Northwestern University; Mehul V. Raval, Northwestern University
• Language: English
• Date: 2022-12-29
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 3.0 United States
• Final Published Version (URL): https://doi.org/10.1016/j.jss.2022.11.071
• Title of Journal or Parent Work: Journal of Surgical Research
• Volume: 284
• Start Page: 204
• End Page: 212
• Grant/Funding Agency: Northwestern Medicine; Crohn’s & Colitis Foundation; National Institutes of Health
• Grant/Funding Information: This research was supported by Crohn’s & Colitis Foundation’s Litwin IBD Pioneers Award (PI: Raval; Award # 571096) and Digestive Health Foundation at Northwestern Medicine (Co-PIs: Raval & Balbale). Additional Support was provided by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD099344.
• Keywords: Enhanced Recovery Protocols; implementation; gastrointestinal surgery; pediatric; qualitative research; ERP
• Subject - Topics: Gastrointestinal system--Diseases; Children--Surgery; Medical protocols

Abstract

Background We explored patient, caregiver, and provider recommendations for development of a toolkit to implement Enhanced Recovery Protocols (ERP) for pediatric patients undergoing gastrointestinal surgery. ERPs are widely used for adults to decrease hospital length of stay, hospital costs and complications while hastening patient recovery after surgery. With limited data available for ERPs among pediatric populations, informed modification of adult ERPs is needed to facilitate successful implementation for pediatric surgery. Materials and Methods Using a qualitative research design, semi-structured interviews were conducted with hospital-based teams including surgeons, anesthesiologists, gastroenterologists, nursing, and physician assistants. Four in-person focus groups (FG) were held at two pediatric hospitals with patients and caregivers. Codes were developed and applied to interview and FG transcripts for structural content analysis. Thematic analysis guided by the Active Implementation Framework, included recommendations that informed ERP implementation toolkit development. Results Key components of the ERP toolkit included the need for a structured and systematic approach, leadership support from key champions, and buy-in from surgical partners and hospital management. Providers identified the need for multimodal educational materials on ERP elements for staff and patients; use of uniform checklists, care sets and an electronic repository to collect outcome data for quality assurance assessment. Patients and caregivers endorsed expansion of the team to include child-life specialists, nutritionists and patient-parent supporters to help navigate the surgical experience. Conclusions This study is the first to leverage key input from patients, caregivers and providers to identify practical components for an ERP implementation toolkit for children undergoing gastrointestinal surgery.