van der Kolk, Marion;
van den Boogaard, Mark;
ter Brugge‐Speelman, Corine;
Hol, Jeroen;
Noyez, Luc;
van Laarhoven, Kees;
van der Hoeven, Hans;
Pickkers, Peter
Development and implementation of a clinical pathway for cardiac surgery in the intensive care unit: Effects on protocol adherence
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Media type:
E-Article
Title:
Development and implementation of a clinical pathway for cardiac surgery in the intensive care unit: Effects on protocol adherence
Contributor:
van der Kolk, Marion;
van den Boogaard, Mark;
ter Brugge‐Speelman, Corine;
Hol, Jeroen;
Noyez, Luc;
van Laarhoven, Kees;
van der Hoeven, Hans;
Pickkers, Peter
imprint:
Wiley, 2017
Published in:Journal of Evaluation in Clinical Practice
Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Rationale, aims and objectives</jats:title><jats:p>Cardiac surgery (CS) is facilitated by multiple perioperative guidelines and protocols. Use of a clinical pathway (CP) may facilitate the care of these patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a pre‐post design study in the ICU of a tertiary referral centre. A CP for CS patients in the ICU was developed by ICU‐nurses and enabled them to execute proactively predefined actions in accordance with and within the preset boundaries which were part of a variance report. A tailored implementation strategy was used. Primary outcome measure was protocol adherence above 80% on the domains of blood pressure control, action on chest tube blood loss and electrolyte control within the CP.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In a 4‐month period, 84 consecutive CP patients were included and compared with 162 matched control patients admitted in the year before implementation; 3 patients were excluded. Propensity score was used as matching parameter. CP patients were more likely to receive early adequate treatment for derangements in electrolytes (96% vs 47%, <jats:italic>P</jats:italic> < .001), blood pressure (90% vs 49%, <jats:italic>P</jats:italic> < .001) and adequate treatment for chest tube blood loss (90% vs 10%, <jats:italic>P</jats:italic> < .001). We found no differences in hospital and ICU LOS, ICU readmission or mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Use of the CP improved postoperative ICU treatment for cardiac surgical patients. Implementation of a CP and the use of a special variance report could be a blueprint for the implementation and use of a CP in low‐volume high complex surgery.</jats:p></jats:sec>