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Hepato - Pancreato -Biliary Surgery. Developing a clinical pathway for patients undergoing pancreatic surgery. Whipple procedure. Pancreatic Surgery. complex abdominal surgery majority cases are performed for cancer strong correlation between volume of surgery and outcomes - PowerPoint PPT Presentation
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Hepato-Pancreato-Biliary SurgeryHepato-Pancreato-Biliary Surgery
Developing a clinical pathway for patients undergoing pancreatic surgery
Pancreatic SurgeryPancreatic Surgery
complex abdominal surgerycomplex abdominal surgery
majority cases are performed for majority cases are performed for cancercancer
strong correlation between strong correlation between volume of surgery and outcomesvolume of surgery and outcomes
↑↑cases performed cases performed ↑ better ↑ better outcomesoutcomes
CCO has designated high CCO has designated high volume centre of excellences in volume centre of excellences in OntarioOntario
Whipple procedure
Study GoalStudy Goal
Improve the quality of surgical care Improve the quality of surgical care for patients undergoing pancreatic for patients undergoing pancreatic surgery in Ontariosurgery in Ontario
Quality in healthcareQuality in healthcare
Structures of CareStructures of Care Characteristics of physicians and hospitalsCharacteristics of physicians and hospitals Context in which care and services are providedContext in which care and services are provided
Process of CareProcess of Care Components of the encounter between a physician Components of the encounter between a physician
or another health care professional and patientsor another health care professional and patients steps that occur during the actual delivery of caresteps that occur during the actual delivery of care
Outcomes of CareOutcomes of Care Changes in patients health status as a result of Changes in patients health status as a result of
health carehealth care
structured multidisciplinary instrumentstructured multidisciplinary instrument
details the steps of care during a defined details the steps of care during a defined patient care episode patient care episode
critical pathwaycritical pathway clinical algorithmclinical algorithm clinical protocol clinical protocol
usually time dependent inventory of actionsusually time dependent inventory of actions
used to standardize processes of careused to standardize processes of care
What is a Clinical Pathway?What is a Clinical Pathway?
adapted from: Rotter T et al, Eval Health Prof, May 2011
Impact of clinical Impact of clinical pathwayspathways
Improved quality of careImproved quality of care standardization of processes of carestandardization of processes of care reduced variabilityreduced variability improved efficiency improved efficiency high quality patient carehigh quality patient care ↑ ↑ documentation documentation improved improved
communicationcommunication
Good economic outcomesGood economic outcomes ↓ ↓ length of staylength of stay ↓ ↓ hospital costshospital costs
Impact of clinical Impact of clinical pathwayspathways
Improved patient outcomesImproved patient outcomes ↓ ↓ length of staylength of stay ↓ ↓ patient morbidity and mortalitypatient morbidity and mortality
↓ ↓ in-hospital complicationsin-hospital complications 5.6% absolute risk reduction (n=5 5.6% absolute risk reduction (n=5
trials)trials)11
Rotter T et al, Eval Health Prof, May 2011
Study QuestionStudy Question
Can we develop an evidence based Can we develop an evidence based clinical pathway for patients clinical pathway for patients undergoing pancreatic surgery?undergoing pancreatic surgery?
Identify current practices and tools being Identify current practices and tools being used at the high volume HPB sites in Ontarioused at the high volume HPB sites in Ontario
Prioritize and rank key elements of patient Prioritize and rank key elements of patient care that should be included in a pancreatic care that should be included in a pancreatic surgery pathwaysurgery pathway
Identify barriers and enablers to will lead to Identify barriers and enablers to will lead to successful and sustainable implementation of successful and sustainable implementation of a clinical pathwaya clinical pathway
Goals for this workshopGoals for this workshop
Summary of clinical Summary of clinical pathway projectpathway project
Walk us through a patient's Walk us through a patient's journey through care after journey through care after undergoing a Whipple at undergoing a Whipple at
your hospitalyour hospital
How are you currently How are you currently managing these managing these
patients? patients?
How do team members How do team members communicate with one communicate with one
another?another?
How do you think we How do you think we might use a clinical might use a clinical
pathway?pathway?
Why do you think we Why do you think we might use a clinical might use a clinical
pathway?pathway?
Prioritize and rank key elements of patient Prioritize and rank key elements of patient care that you feel should be included in a care that you feel should be included in a pancreatic surgery clinical pathwaypancreatic surgery clinical pathway
Provide additional comments/ inputProvide additional comments/ input does pathway have face validity?does pathway have face validity? are there missing items?are there missing items? do items that need clarification?do items that need clarification?
multi-disciplinary clinical pathway mapmulti-disciplinary clinical pathway map pre-printed MD orderspre-printed MD orders
Which elements should be Which elements should be included?included?
Multidisciplinary clinical Multidisciplinary clinical pathwaypathway
Pre-Admission
OR DayPre-op
OR DayPost-op
POD # 1 POD # 2 POD # 3 POD # 4,5,6 Discharge Day
Date:
Assessments
Education
Observation
Pain Management
Nutrition
Activity
DischargePlanning
Proceed/ Discontinue CP (Y/N)
Physician Signature
Pre-printed MD ordersPre-printed MD ordersPre-
Admission/Pre-Surgical
OR DayPre-op
OR DayPost-op
POD # 1 POD # 2 POD # 3 POD # 4,5,6
POD # 6,7 Discharge
day
Diet
Activity
Vitals
Investigations
Interventions
Drugs
Benchmarking draft Benchmarking draft clinical pathwayclinical pathway
50 patient charts reviewed50 patient charts reviewed 38 (76%) patients on pathway38 (76%) patients on pathway
Average length of stay = 8.15 daysAverage length of stay = 8.15 days 12 (24%) patients went off pathway12 (24%) patients went off pathway
Average length of stay = 18.17 daysAverage length of stay = 18.17 days
Benchmarking draft Benchmarking draft clinical pathwayclinical pathway
highest variability in postoperative highest variability in postoperative nutrition, pain management and activity nutrition, pain management and activity (ambulation (ambulation
elements most commonly missing elements most commonly missing patient education patient education discharge planningdischarge planning
Wrap upWrap up
please hand in score sheetsplease hand in score sheets sign consent formssign consent forms consider joining the working groupconsider joining the working group
Thank you!Thank you!