[Implementation of a fast track program : Challenges and solution approaches].
Implementierung eines Fast-Track-Programmes : Herausforderungen und Lösungsansätze.
Colorectal Surgery
Compliance
Fast Track Surgery
Introduction
Obstacles
Perioperative medicine
Journal
Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen
ISSN: 1433-0385
Titre abrégé: Chirurg
Pays: Germany
ID NLM: 16140410R
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
pubmed:
3
8
2019
medline:
3
3
2020
entrez:
3
8
2019
Statut:
ppublish
Résumé
For more than a decade the evolving concept of fast track surgery has been implemented, predominantly in colorectal surgery. The practice of fast track surgery has yielded excellent results concerning reduction of postoperative complications and hospital stay and has been shown to increase patient satisfaction; however, several studies have shown a sometimes alarmingly low rate of implementation of the individual fast track measures and the rate is a maximum of 44%. In this review, obstacles for implementation of fast track surgery are investigated. Advice is given on possible solutions to circumvent obstacles and facilitate successful establishment of multimodal recovery protocols in individual institutions. The current international literature is critically evaluated and discussed with a particular focus on prospective clinical trials and expert recommendations. The reasons for a lack of adherence to fast track surgery principles have been shown to be multifactorial. Time-consuming expenditure, logistic difficulties, lack of support by colleagues as well as limitations in the healthcare system and patient-dependent factors appear to complicate implementation of fast track programs. Successful implementation and long-term perpetuation can be achieved only by an interdisciplinary team with a low level hierarchy, continuous training and a positive feedback culture. An early inclusion and clarification of personnel and patients should be firmly integrated into the fast track concept. This results in a higher satisfaction of patients and personnel and subsequently stronger adherence to the fast track concept.
Sections du résumé
BACKGROUND
BACKGROUND
For more than a decade the evolving concept of fast track surgery has been implemented, predominantly in colorectal surgery. The practice of fast track surgery has yielded excellent results concerning reduction of postoperative complications and hospital stay and has been shown to increase patient satisfaction; however, several studies have shown a sometimes alarmingly low rate of implementation of the individual fast track measures and the rate is a maximum of 44%.
OBJECTIVE
OBJECTIVE
In this review, obstacles for implementation of fast track surgery are investigated. Advice is given on possible solutions to circumvent obstacles and facilitate successful establishment of multimodal recovery protocols in individual institutions.
MATERIAL AND METHODS
METHODS
The current international literature is critically evaluated and discussed with a particular focus on prospective clinical trials and expert recommendations.
RESULTS
RESULTS
The reasons for a lack of adherence to fast track surgery principles have been shown to be multifactorial. Time-consuming expenditure, logistic difficulties, lack of support by colleagues as well as limitations in the healthcare system and patient-dependent factors appear to complicate implementation of fast track programs.
CONCLUSION
CONCLUSIONS
Successful implementation and long-term perpetuation can be achieved only by an interdisciplinary team with a low level hierarchy, continuous training and a positive feedback culture. An early inclusion and clarification of personnel and patients should be firmly integrated into the fast track concept. This results in a higher satisfaction of patients and personnel and subsequently stronger adherence to the fast track concept.
Identifiants
pubmed: 31372676
doi: 10.1007/s00104-019-1009-y
pii: 10.1007/s00104-019-1009-y
doi:
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
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