Anne-Claude Griesser

Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery.

Enhanced recovery protocols may reduce postoperative complications and length of hospital stay. However, the implementation of these protocols requires time and financial investment. This study evaluated the cost‐effectiveness of enhanced recovery implementation.

Cost–benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy

Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost‐effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy.

Collaborative Quality Improvement to Manage Pain in Acute Care Hospitals

OBJECTIVE Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. DESIGN To assess the effectiveness of the program, we performed a before-after trial comparing patients self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). SETTING A teaching hospital of 2,096 beds in Geneva, Switzerland. PATIENTS All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). INTERVENTIONS Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. OUTCOME MEASURES Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). RESULTS After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P=0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P=0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P=0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P=0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P=0.046). CONCLUSION Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.

Work related characteristics of back and neck pain among employees of a Swiss University Hospital

OBJECTIVES 1) To explore the staff- and work-related risk factors for spinal pain among hospital employees, 2) to investigate the effect of staff- and work-related variables on the consequences of spinal pain, such as doctor visits and sick leave. METHODS A mailed survey was carried out in a random sample of 2700 employees stratified for occupational categories (administration staff, nurses, nurse assistants, physicians, support staff and allied health professionals). The questionnaire measured self-reported spinal pain, consequences of pain, and work characteristics. RESULTS The response rate was 48.1% (1298/2700). The one-year prevalence of spinal pain was 67.3%, highest among nurses (75.6%) and lowest among support staff (54.9%). Reported work characteristics associated with spinal pain included frequent work at a poorly adapted work station (odds ratio (OR) 1.90 [1.24-2.93]) and having to maintain a position for a long time (OR 1.71 [1.25-2.34]). No significant correlations were observed with lifting, patient handling, material handling, or working on nightshift. Sickness leave due to spinal pain was significantly associated with duration of pain episode (OR 4.08 for>3 months compared to less than 10 days), and with work categories (OR 2.58 for nurse assistants compared to nurses). CONCLUSION In this population of hospital employees, being a nurse, working at a poorly adapted work place, and having to maintain positions for a long time were related independently to spinal pain. Nurse assistants had a higher risk of work absenteeism.

The impact of an enhanced recovery pathway on nursing workload: A retrospective cohort study ☆

BACKGROUND & AIMS The importance of nursing for surgical patients has been frequently underestimated. The success of enhanced recovery programs after surgery (ERAS) depends on preferably complete fulfillment of the protocol and nurses are an important part of it. Due to the additional nursing action required, such protocols are suspected to increase the nursing workload. The aim of the present study was to observe and measure objectively nursing workload before, during and after systematic implementation of a comprehensive enhanced recovery pathway in colorectal surgery. METHODS The program ERAS was introduced systematically in our tertiary academic centre 2011, since then our experience is based on more than 1500 ERAS patients. Nursing workload was prospectively assessed for all patients on a routine basis by means of a standardized and validated point system (PRN). In a retrospective cohort study, we compared nursing workload based on prospective data before, during and after ERAS implementation and correlated nursing workload to the compliance with the ERAS protocol. RESULTS The study cohort included 50 patients before ERAS implementation (2010) and 69 (2011) and 148 (2012) consecutive patients after implementation; the baseline characteristics of the 3 groups were similar. Mean PRN values were 61.2 ± 19.7 per day in 2010 and decreased to 52.3 ± 13.7 (P = 0.005) and 51.6 ± 18.6 (P < 0.002) in 2011 and 2012, respectively. Increasing compliance with the ERAS protocol was significantly correlated to decreasing nursing workload (ρ = -0.42; P < 0.001). CONCLUSIONS Nursing workload is--against a common belief--decreased by systematic implementation of enhance recovery protocol. The higher the compliance with the pathway, the lower the burden for the nurses!

Assessment of Avoidable Readmissions in a Visceral Surgery Department with an Algorithm: Methodology, Analysis and Measures for Improvement

BackgroundStandardized quality indicators assessing avoidable readmission become increasingly important in health care. They can identify improvements area and contribute to enhance the care delivered. However, the way of using them in practice was rarely described.MethodsRetrospective study uses prospective inpatients’ information. Thirty-day readmissions were deemed potentially avoidable or non-avoidable by a computerized algorithm, and annual rate was reported between 2010 and 2014. Observed rate was compared to expected rate, and medical record review of potentially avoidable readmissions was conducted on data between January and June 2014.ResultsDuring a period of ten semesters, 11,011 stays were screened by the algorithm and a potentially avoidable readmission rate (PAR) of 7% was measured. Despite stable expected rate of 5 ± 0.5%, an increase was noted concerning the observed rate since 2012, with a highest value of 9.4% during the first semester 2014. Medical chart review assessed the 109 patients screened positive for PAR during this period and measured a real rate of 7.8%. The delta was in part due to an underestimated case mix owing to sub-coded comorbidities and not to health care issue.ConclusionsThe present study suggests a methodology for practical use of data, allowing a validated quality of care indicator. The trend of the observed PAR rate showed a clear increase, while the expected PAR rate was stable. The analysis emphasized the importance of adequate “coding chain” when such an algorithm is applied. Moreover, additional medical chart review is needed when results deviate from the norm.

Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study: Transition plan at discharge of patients hospitalized with HF

We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients.