Utilization of and barriers to enhanced recovery pathway implementation in pediatric urology

Chan, Yvonne Y.; Rosoklija, Ilina; Meade, Patrick; Burjek, Nicholas E.; Raval, Mehul V.; Yerkes, Elizabeth B.; Rove, Kyle O.; Chu, David I.

doi:10.1016/j.jpurol.2021.01.044

Cited by 16 publications

(10 citation statements)

References 32 publications

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“…Buy-in from all possible stakeholders is crucial in ensuring pathway implementation success. 17 The results of our study show that implementation of a multidisciplinary care pathway for the management of children at risk of VCD is safe and feasible. No patients reported any pathway related adverse effects and any delays in hospital discharge early in the project were mitigated through use of an implementation science approach.…”

Section: Discussionmentioning

confidence: 67%

“…Other researchers also propose that success of pathway implementation is related to strong collaboration between specialists within the health system and that buy-in from colleagues and leadership is important to mitigate barriers of long-term standardized pathway use. 17,23,24 Such an approach is gaining recognition in paediatric cardiac surgery as evidenced by two successful projects in which clinical pathways were implemented resulting in decreased length of stay and healthcare cost. 7,25 Acknowledgements.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

et al. 2021

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Every year in Australia over a thousand children who are born with congenital heart disease require surgical intervention. Vocal cord dysfunction (VCD) can be an unavoidable and potentially devastating complication of surgery for congenital heart disease. Structured, multidisciplinary care pathways help to guide clinical care and reduce mortality and morbidity. An implementation study was conducted to embed a novel, multidisciplinary management pathway into practice using the consolidated framework for implementation research (CFIR). The goal of the pathway was to prepare children with postoperative vocal cord dysfunction to safely commence and transition to oral feeding. Education sessions to support pathway rollout were completed with clinical stakeholders. Other implementation strategies used included adaptation of the pre-procedural pathway to obtain consent, improving the process of identifying patients on the VCD pathway, and nominating a small team who were responsible for the ongoing monitoring of patients following recruitment. Implementation success was evaluated according to compliance with pathway defined management. Our study found that while there were several barriers to pathway adoption, implementation of the pathway was feasible despite pathway adaptations that were required in response to COVID-19.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

et al. 2021

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“…While 54% utilized some individual ERP elements, only 20% had a complete standardized pathway. 25 In our study, 85% of Urologists indicated that opioid prescriptions are not guided by institutional guidelines. This is consistent with these findings, which joins an increasing body of evidence that opioid prescription behavior is not standardized.…”

Section: Commentmentioning

confidence: 63%

Institutional Opioid Prescription Guidelines are Effective in Reducing Post-Operative Prescriptions Following Urologic Surgery: Results From the American Urologic Association 2018 Census

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Nabavizadeh

et al. 2021

Urology

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“…However, unique to the Kasai procedure are the avoidance of acetaminophen given hepatic disease, consideration of coagulopathy with regional anesthesia, focus on multimodal pain control for a relatively larger surgical incision, and need for postoperative antibiotics given the ongoing infectious risk. Furthermore, the lack of knowledge of ERPs is a major barrier to implementation [ 39 ]. By incorporating standard neonatal anesthetic practices and highlighting Kasai procedure specific components, we hope to bring awareness of neonatal ERPs to expand utilization.…”

Section: Discussionmentioning

confidence: 99%

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

et al. 2022

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Balancing post-operative adequate pain control, respiratory depression, and return of bowel function can be particularly challenging in infants receiving the Kasai procedure (hepatoportoenterostomy). We performed a retrospective chart review of all patients who underwent the Kasai procedure from a single surgeon at Children’s Healthcare of Atlanta from 1 January 2018, to 1 September 2022. 12 patients received the Kasai procedure within the study period. Average weight was 4.47 kg and average age was 7.4 weeks. Most patients received multimodal pain management including dexmedetomidine and/or ketorolac along with intravenous opioids. A balance of colloid and crystalloids were used for all patients; 57% received blood products as well. All patients were extubated in the OR and transferred to the general surgical floor without complications. Return of bowel function occurred in all patients by POD2, and enteral feeds were started by POD3. One patient had a presumed opioid overdose while admitted requiring a rapid response and brief oxygen supplementation. Simultaneously optimizing pain control, respiratory safety, and bowel function is possible in infants receiving the Kasai procedure. Based on our experience and the current pediatric literature, we propose an enhanced recovery protocol to improve patient outcomes in this fragile population. Larger, prospective studies implementing an enhanced recovery protocol in the Kasai population are required for stronger evidence and recommendations.

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Utilization of and barriers to enhanced recovery pathway implementation in pediatric urology

Cited by 16 publications

References 32 publications

Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

Institutional Opioid Prescription Guidelines are Effective in Reducing Post-Operative Prescriptions Following Urologic Surgery: Results From the American Urologic Association 2018 Census

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

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