Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Department of Surgery and Cancer, Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
World J Surg. 2021 Feb;45(2):347-355. doi: 10.1007/s00268-020-05810-w. Epub 2020 Oct 20.
Randomised trials have shown an Enhanced Recovery Program (ERP) can shorten stay after colorectal surgery. Previous research has focused on patient compliance neglecting the role of care providers. National data on implementation and adherence to standardised care are lacking. We examined care organisation and delivery including the ERP, and correlated this with clinical outcomes.
A cross-sectional questionnaire was administered to surgeons and nurses in August-October 2015. All English National Health Service Trusts providing elective colorectal surgery were invited. Responses frequencies and variation were examined. Exploratory factor analysis was performed to identify underlying features of care. Standardised factor scores were correlated with elective clinical outcomes of length of stay, mortality and readmission rates from 2013-15.
218/600 (36.3%) postal responses were received from 84/90 (93.3%) Trusts that agreed to participate. Combined with email responses, 301 surveys were analysed. 281/301 (93.4%) agreed or strongly agreed that they had a standardised, ERP-based care protocol. However, 182/301 (60.5%) indicated all consultants managed post-operative oral intake similarly. After factor analysis, higher hospital average ERP-based care standardisation and clinician adherence score were significantly correlated with reduced length of stay, as well as higher ratings of teamwork and support for complication management.
Standardised, ERP-based care was near universal, but clinician adherence varied markedly. Units reporting higher levels of clinician adherence achieved the lowest length of stay. Having a protocol is not enough. Careful implementation and adherence by all of the team is vital to achieve the best results.
随机试验表明，增强康复计划（ERP）可缩短结直肠手术后的住院时间。先前的研究侧重于患者的依从性，而忽略了护理提供者的作用。缺乏有关实施和遵守标准化护理的国家数据。我们检查了护理组织和实施情况，包括 ERP，并将其与临床结果相关联。
2015 年 8 月至 10 月，对外科医生和护士进行了横断面问卷调查。邀请所有提供择期结直肠手术的英国国民保健服务信托参与。检查了响应频率和变化。进行探索性因素分析以确定护理的基本特征。将标准化因子评分与 2013-15 年的住院时间、死亡率和再入院率等择期临床结果相关联。
从同意参与的 90 个信托中的 84 个信托中收到了 600 个（36.3％）的 218/600 个邮政回复。加上电子邮件回复，共分析了 301 个调查。281/301（93.4％）同意或强烈同意他们有标准化的，基于 ERP 的护理方案。但是，182/301（60.5％）表示所有顾问管理术后口服摄入的方式相似。经过因子分析，医院平均基于 ERP 的护理标准化和临床医生依从性评分较高与住院时间缩短以及团队合作和并发症管理支持的评分较高相关。
标准化，基于 ERP 的护理几乎是普遍的，但临床医生的依从性差异很大。报告临床医生依从性较高的单位住院时间最短。有方案还不够。团队的所有成员都必须仔细实施和遵守，才能取得最佳效果。
