Perioperative care map improves compliance with best practices for the morbidly obese

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• 作者：Ian Solsky ; MD^a ; Alex Edelstein ; BS^b ; Michael Brodman ; MD^b ; Ronald Kaleya ; MD^c ; Meg Rosenblatt ; MD^b ; Calie Santana ; MD^a ; David L. Feldman ; MD^d ; Patricia Kischak ; RN ; MBA ; CPHRM^d ; Donna Somerville ; MS ; CPHQ^d ; Santosh Mudiraj ; MBBS ; MPH^d ; I. Michael Leitman ; MD ; FACS^b ; Peter Shamamian ; MD^a ; ^{pshamami@montefiore.org" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：160
• 期：6
• 页码：1682-1688
• 全文大小：318 K

文摘

Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients.

d="absSec_2">Methods

d="abspara0015">A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013. Pre- and postintervention surveys were sent to participants in 2012 and in 2015 to evaluate changes in clinical practice. A chart audit performed postintervention determined physician compliance with distributed guidelines.

d="absSec_3">Results

d="abspara0020">In the study, 567 physicians completed the survey in 2012 and 375 physicians completed the survey in 2015. Postintervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese, operatively treated patients to comply with best practices preoperatively (89% vs 59%), intraoperatively (71% vs 54%), postoperatively (80% vs 57%), and overall (88% vs 72%). Results were similar when surgeons and anesthesiologists were analyzed separately. A chart audit of 170 cases from the 4 hospitals found that 167 (98%) cases were compliant with best practices.

d="absSec_4">Conclusion

d="abspara0025">After care map distribution, the percentage of physicians who reported changing their management to match best practices significantly improved. These findings highlight the beneficial impact this educational intervention can have on physician behavior. Continued investigation is needed to evaluate the influence of this intervention on clinical outcomes.