scholarly journals Implementing an enhanced recovery after thoracic surgery programme in the Netherlands: a qualitative study investigating facilitators and barriers for implementation

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e051513
Author(s):  
Erik M. von Meyenfeldt ◽  
Femke van Nassau ◽  
Carlijn T I de Betue ◽  
L Barberio ◽  
Wilhelmina H Schreurs ◽  
...  
Keyword(s):  
Lung Cancer ◽  
The Netherlands ◽  
Thoracic Surgery ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Implementation Strategies ◽  
Audit And Feedback ◽  
Successful Implementation ◽  
Hospital To Home ◽  
The Impact

ObjectivesThis study aims to elucidate determinants for succesful implementation of the Enhanced Recovery After Thoracic Surgery (ERATS) protocol for perioperative care for surgical lung cancer patients in the Netherlands.SettingLung cancer operations are performed in both academic and regional hospitals, either by cardiothoracic or general thoracic surgeons. Limiting the impact of these operations by optimising and standardising perioperative care with the ERATS protocol is thought to enable reduction in length of stay, complications and costs.ParticipantsA broad spectrum of stakeholders in perioperative care for patients with lung resection participated in this study, ranging from patient representatives, healthcare professionals to an insurance company representative.InterventionsSemistructured interviews (N=14) were conducted with the stakeholders (N=18). The interviews were conducted one on one by telephone and two times, face to face, in small groups. Verbatim transcriptions of these interviews were coded for the purpose of thematic analysis.Outcome measuresDeterminants for successful implementation of the ERATS protocol in the Netherlands.ResultsSeveral determinants correspond with previous publications: having a multidisciplinary team, leadership from a senior clinician and support from an ERAS-coordinator as facilitators; lack of feedback on performance and absence of management support as barriers. Our study underscores the potential detrimental effect of inconsistent communication, the lack of support in the transition from hospital to home and the barrier posed by lack of accessible audit data.ConclusionsBased on a structured problem analysis among a wide selection of stakeholders, this study provides a solid basis for choosing adequate implementation strategies to introduce the ERATS protocol in the Netherlands. Emphasis on consistent and sufficient communication, support in the transition from hospital to home and adequate audit and feedback data, in addition to established implementation strategies for ERAS-type programmes, will enable a tailored approach to implementation of ERATS in the Dutch context.

scholarly journals The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer

2018 ◽  
Vol 155 (4) ◽  
pp. 1843-1852 ◽  
Author(s):  
Luke J. Rogers ◽  
David Bleetman ◽  
David E. Messenger ◽  
Natasha A. Joshi ◽  
Lesley Wood ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Primary Lung Cancer ◽  
Protocol Compliance ◽  
Eras Protocol ◽  
The Impact

scholarly journals Developing implementation strategies to adopt Enhanced Recovery After Surgery (ERAS®) guidelines

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Jennifer Y Lam ◽  
Alexandra Howlett ◽  
Duncan McLuckie ◽  
Lori M Stephen ◽  
Scott D N Else ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Pathways ◽  
Audit System ◽  
Local Contexts

Abstract Background Strong implementation strategies are critical to the success of Enhanced Recovery after Surgery (ERAS®) guidelines, though little documentation exists on effective strategies, especially in complex clinical situations and unfamiliar contexts. This study outlines the process taken to adopt a novel neonatal ERAS® guideline. Methods The implementation strategy was approached in a multi-pronged, concurrent but asynchronous fashion. Between September 2019 and January 2020, healthcare providers from various disciplines and different specialties as well as parents participated in the strategy. Multidisciplinary teams were created to consider existing literature and local contexts including potential facilitators and/or barriers. Task forces worked collaboratively to develop new care pathways. An audit system was developed to record outcomes and elicit feedback for revision. Results 32 healthcare providers representing 9 disciplines and 5 specialties as well as 8 parents participated. Care pathways and resources were created. Elements recommended for a successful implementation strategy included identification of champions, multidisciplinary stakeholder involvement, consideration of local contexts and insights, patient/family engagement, education, and creation of an audit system. Conclusion A multidisciplinary and structured process following principles of implementation science was used to develop an effective implementation strategy for initiating ERAS® guidelines.

scholarly journals Surgeon Knowledge of the Pulmonary Arterial System and Surgical Plan Confidence Is Improved by Interactive Virtual 3D-CT Models of Lung Cancer Patient Anatomies

2021 ◽  
Vol 8 ◽  
Author(s):  
Kunal Bhakhri ◽  
Eoin R. Hyde ◽  
Sze M. Mak ◽  
Lorenz U. Berger ◽  
Sebastien Ourselin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Video Recording ◽  
Arterial System ◽  
3D Ct ◽  
Anatomical Structures ◽  
Segmental Artery ◽  
Robotic Assisted ◽  
Pulmonary Arterial ◽  
The Impact

Objective: Interactive three-dimensional virtual models of pulmonary structures (3D-CT) may improve the safety and accuracy of robotic-assisted thoracic surgery (RATS). The aim of this study was to evaluate the impact of 3D-CT models as an imaging adjunct on surgical confidence and anatomical assessment for lobectomy planning.Methods: We retrospectively analyzed the response of 10 specialist thoracic surgeons who each reviewed 10 pre-operative images of patients undergoing robotic-assisted lobectomy lung cancer cases from June to November 2018 in our institute, resulting in 100 data points. The number of arteries, veins, and bronchi entering the resected lobes were determined from the operation video recording by the operating surgeon. 3D-CT models were generated for each case and made available for online visualization and manipulation. Thoracic surgeons were invited to participate in the survey which consisted of evaluation of CT (control) and 3D-CT (intervention) models. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.Results: Ten participants were recruited. 3D-CT models led to a significant (p < 0.003) increase in the surgeons' ability to correctly identifying pulmonary arteries entering the resection lobes in 35% (CT) and 57% (3D-CT) of cases. A significant (p < 1e-13) improvement in anatomy assessment and surgical plan confidence was observed for the 3D-CT arm, with median Likert scale scores of “2–Slightly easy” (CT) and “4–Very easy” (3D-CT).Conclusion: The use of 3D-CT models for thoracic surgery planning increases the surgeon confidence in recognizing anatomical structures, largely by enhanced appreciation of anatomical variations in the segmental pulmonary arterial system. Further studies are needed to investigate if 3D-CT models can be used in providing precise information about segmental artery distribution and therefore surgical planning of sub-lobar resections.

scholarly journals The impact of certification of general thoracic surgeons on lung cancer mortality: a survey by The Japanese Association for Thoracic Surgery

2016 ◽  
Vol 49 (5) ◽  
pp. e134-e140 ◽  
Author(s):  
Takeshi Nagayasu ◽  
Shuntaro Sato ◽  
Hiroshi Yamamoto ◽  
Naoya Yamasaki ◽  
Tomoshi Tsuchiya ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Cancer Mortality ◽  
Lung Cancer Mortality ◽  
Japanese Association ◽  
The Impact

scholarly journals How to foster successful implementation of a patient reported experience measurement in the disability sector: an example of developing strategies in co-creation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Marjolein van Rooijen ◽  
Anneke van Dijk-de Vries ◽  
Stephanie Lenzen ◽  
Ruth Dalemans ◽  
Albine Moser ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Implementation Process ◽  
Successful Implementation ◽  
Participatory Action ◽  
Policy And Practice ◽  
Link Type ◽  
Tailored Implementation ◽  
Patient Reported ◽  
Strategy Changes ◽  
The Impact

Abstract Background The integrated uptake of patient-reported experience measures, using outcomes for the micro, meso and macro level, calls for a successful implementation process which depends on how stakeholders are involved in this process. Currently, the impact of stakeholders on strategies to improve the integrated use is rarely reported, and information about how stakeholders can be engaged, including care-users who are communication vulnerable, is limited. This study illustrates the impact of all stakeholders on developing tailored implementation strategies and provides insights into supportive conditions to involve care-users who are communication vulnerable. Methods With the use of participatory action research, implementation strategies were co-created by care-users who are communication vulnerable (n = 8), professionals (n = 12), management (n = 6) and researchers (n = 5) over 9 months. Data collection consisted of audiotapes, reports, and researchers’ notes. Conventional content analysis was performed. Results The impact of care-users concerned the strategies’ look and feel, understandability and relevance. Professionals influenced impact on how to use strategies and terminology. The impact of management was on showing the gap between policy and practice, and learning from previous improvement failures. Researchers showed impact on analysis, direction of strategy changes and translating academic and development experience into practice. The engagement of care-users who are communication vulnerable was supported, taking into account organisational issues and the presentation of information. Conclusions The impact of all engaged stakeholders was identified over the different levels strategies focused on. Care-users who are communication vulnerable were valuable engaged in co-creation implementation strategies by equipping them to their needs and routines, which requires adaptation in communication, delimited meetings and a safe group environment. Trial registration Reviewed by the Medical Ethics Committee of Zuyderland-Zuyd (METCZ20190006). NL7594 registred at https://www.trialregister.nl/.

scholarly journals The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 228
Author(s):  
Francesco Petrella ◽  
Davide Radice ◽  
Juliana Guarize ◽  
Gaia Piperno ◽  
Cristiano Rampinelli ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Pulmonary Nodule ◽  
Multidisciplinary Team ◽  
Patient Management ◽  
Solitary Pulmonary Nodule ◽  
Advanced Lung Cancer ◽  
Clinical Settings ◽  
Suspected Recurrence ◽  
The Impact

Background: the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation. Methods: the impact of MDT was classified as follows: confirmation: same conclusions as out-patient hypothesis; modification: change of out-patient hypothesis; implementation: definition of a clear clinical track/conclusion for patients that did not receive any clinical hypothesis; further exams required: the findings that emerged in the MDT meeting require further exams. Results: one thousand consecutive patients evaluated at MDT meetings were enrolled. Clinical settings of patients were: early stage lung cancer (17.4%); locally advanced lung cancer (27.4%); stage IV lung cancer (9.8%); mesothelioma (1%); metastases to the lung from other primary tumors (4%); histologically proven or suspected recurrence from previous lung cancer (15%); solitary pulmonary nodule (19.2%); mediastinal tumors (3.4%); other settings (2.8%). Conclusions: MDT meetings impact patient management in oncologic thoracic surgery by modifying the out-patient clinical hypothesis in 10.6% of cases; the clinical settings with the highest decisional modification rates are “solitary pulmonary nodule” and “proven or suspected recurrence” with modification rates of 14.6% and 13.3%, respectively.

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