Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

Abstract

Background To improve perioperative patient safety, guidelines for the preoperative, peroperative, and postoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation of these guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guideline adherence and to explore what can be learned for future implementation projects in complex organizations. Methods We developed a questionnaire survey based on the theoretical framework of Van Sluisveld et al. for classifying barriers and facilitators. The questionnaire contained 57 statements derived from (a) an instrument for measuring determinants of innovations by the Dutch Organization for Applied Scientific Research, (b) interviews with quality and safety policy officers and perioperative professionals, and (c) a publication of Cabana et al. The target group consisted of 232 perioperative professionals in nine hospitals. In addition to rating the statements on a five-point Likert scale (which were classified into the seven categories of the framework: factors relating to the intervention, society, implementation, organization, professional, patients, and social factors), respondents were invited to rank their three most important barriers in a separate, extra open-ended question. Results Ninety-five professionals (41%) completed the questionnaire. Fifteen statements (26%) were considered to be barriers, relating to social factors ( N = 5), the organization ( N = 4), the professional ( N = 4), the patient ( N = 1), and the intervention ( N = 1). An integrated information system was considered an important facilitator (70.4%) as well as audit and feedback (41.8%). The Barriers Top-3 question resulted in 75 different barriers in nearly all categories. The most frequently reported barriers were as follows: time pressure (16% of the total number of barriers), emergency patients (8%), inefficient IT structure (4%), and workload (3%). Conclusions We identified a wide range of barriers that are believed to hinder the use of the perioperative safety guidelines, while an integrated information system and local data collection and feedback will also be necessary to engage perioperative teams. These barriers need to be locally prioritized and addressed by tailored implementation strategies. These results may also be of relevance for guideline implementation in general in complex organizations. Trial registration Dutch Trial Registry: NTR3568 .

Complexity and involvement as implementation challenges: results from a process analysis

“…The IMPROVE-implementation programme involves a multifaceted intervention within the perioperative setting, tailored to: local barriers identified prospectively in the participating hospitals [ 15 ]; current performance and guideline adherence in the hospitals; and local needs and initiatives already realized or planned in the hospital. It uses evidence from scientific literature (systematic review of interventions by Grimshaw et al [ 8 ]); expert opinion (perioperative healthcare professionals as well as implementation experts [ N = 13 and 11 experts respectively, there was no overlap between groups] were asked to rate potential interventions in terms of their usefulness in improving perioperative guideline adherence) and knowledge and experience of the research team regarding the feasibility of the interventions (estimated costs, effort, and time for the hospitals as well as the research team) [ 21 ].…”

“…This framework is based on three models related to implementing change: the implementation of change-model of Grol and Wensing [ 25 , 26 ]; the framework of knowledge–attitude–behaviour-related barriers for guideline adherence of Cabana et al [ 27 ]; and the framework for adherence to clinical practice guidelines in the intensive care unit of Cahill et al [ 28 ]. We used the framework of Van Sluisveld et al also for our barrier analysis, prior to the actual implementation of the perioperative guidelines [ 15 ]. The categories of the framework van Van Sluisveld et al [ 24 ] relate to: 1. intervention characteristics (e.g.…”

“…The IMPROVE-implementation programme was developed based on an extensive analysis of the barriers and facilitators for the implementation of the national perioperative safety guidelines [ 15 ]. To evaluate the impact of the IMPROVE-implementation programme on the safety of perioperative care (see Additional file 1 ), we conducted a stepped-wedge cluster-randomized trial in nine hospitals (three groups of three hospitals each) in the Netherlands (Emond et al: Increased adherence to the national perioperative safety guidelines associated with improved patient safety outcomes.…”

The quality and continuity of systemic postoperative analgesia: a single center two-stage follow-up study

“…Adoption of clinical guidelines consists of 2 categories: primary strategies involving creation, mailing and publication, and secondary interventional strategies to reinforce the guidelines [18]. Emond et al [19] (2020) have found that obstacles for implementation of patient safety guidelines in the perioperative setting in the Netherlands were: time barrier (16% of the total number of barriers), emergency patients (8%), inefficient Information Technology (IT) structure (4%) and workload (3%). Van Gulik et al [20] have found that adherence is especially poor in terms of nonscheduled, flowchart-guided interventions.…”

Barriers and facilitators to evidence‐based perioperative hypothermia management for orthopaedic patients: A systematic review

“…A qualitative study of multidisciplinary participants utilizing the Theoretical Domains Framework (TDF) by Munday et al (2019) identified a lack of knowledge around guidelines as well as social and environmental barriers. A Dutch survey focused on perioperative safety guidelines reported social and organizational barriers; perceptions that adherence to guidelines delay workflow and impacts routines, and that staff also did not always follow guidelines during emergency cases and believed patients would not expect them to as common barriers (Emond et al, 2020). Potential facilitators to improve uptake of guidelines included integrated information systems with audit and feedback; education; digital checklists as well as availability of warming and monitoring devices (Emond et al, 2020;Munday et al, 2019).…”