Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2023 Jul 26;13(7):e075008. doi: 10.1136/bmjopen-2023-075008.
Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact.
A mixed-methods Effectiveness-Implementation Hybrid (type III) pre-post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The individual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15-20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways.
This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders.
解决择期手术中的临床差异具有挑战性。一个关键问题是如何在很大程度上自主的临床医生之间达成共识。了解共识过程如何制定和实施围手术期路径，以及这些路径对减少临床差异的影响，可以为共识过程的有效性提供重要的见解。本研究的主要目的是了解在私立医疗机构中实施组织支持的、基于共识的围手术期护理路径的情况，并确定其影响。
将在澳大利亚一家私立医院进行一项混合方法的有效性-实施混合（III 型）前后研究。将为特定患者群体开发和实施 5 种新的基于共识的围手术期护理路径：脊柱手术、根治性前列腺切除术、心脏手术、减重手术以及全髋关节和膝关节置换术。这些路径的各个组成部分将作为共识建立方法的一部分得到确认，并将遵循使用探索、准备、实施和维持框架的四个阶段实施过程。将通过对主要临床和非临床工作人员进行半结构化访谈和焦点小组以及参与者观察，评估实施过程以及障碍和促进因素。我们预计将完成 30 次访谈和 15-20 次会议观察。将分析至少 152 名参与者的行政和临床终点，以评估路径的有效性。
本研究已获得麦考瑞大学人类研究伦理医学科学委员会的伦理批准（参考编号：520221219542374）。本研究的结果将通过同行评议的出版物、会议演讲和报告传播给主要利益相关者。
