The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study.
Implementation science
Older people
Perioperative care
Qualitative research
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
15 Mar 2024
15 Mar 2024
Historique:
received:
09
12
2023
accepted:
08
03
2024
medline:
18
3
2024
pubmed:
16
3
2024
entrez:
16
3
2024
Statut:
epublish
Résumé
The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK. A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR). Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services. Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.
Sections du résumé
BACKGROUND
BACKGROUND
The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK.
METHODS
METHODS
A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR).
RESULTS
RESULTS
Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services.
CONCLUSIONS
CONCLUSIONS
Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.
Identifiants
pubmed: 38491431
doi: 10.1186/s12913-024-10844-0
pii: 10.1186/s12913-024-10844-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
345Informations de copyright
© 2024. The Author(s).
Références
Partridge JS, Moonesinghe SR, Lees N, Dhesi JK. Perioperative care for older people. Age Ageing. 2022;51:afac194.
doi: 10.1093/ageing/afac194
pubmed: 36040439
Fowler A, Abbott T, Prowle J, Pearse R. Age of patients undergoing surgery. Br J Surg. 2019;106(8):1012–18.
doi: 10.1002/bjs.11148
pubmed: 31115918
Centre for Perioperative Care. Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery. 2021. https://www.cpoc.org.uk/sites/cpoc/files/documents/2021-09/CPOC-BGS-Frailty-Guideline-2021.pdf . Accessed 31 October 2022.
Australian and New Zealand College of Anaesthetists. A framework for perioperative care in Australia and New Zealand. 2021. https://www.anzca.edu.au/safety-advocacy/standards-of-practice/the-perioperative-care-framework . Accessed 31 October 2022.
Thillainadesan J, Hilmer S, Close J, Kearney L, Naganathan V. Geriatric medicine services for older surgical patients in acute hospitals: results from a binational survey. Australas J Ageing. 2019;38(4):278–83.
doi: 10.1111/ajag.12675
pubmed: 31099179
Joughin AL, Partridge JSL, O’Halloran T, Dhesi JK. Where are we now in perioperative medicine? Results from a repeated UK survey of geriatric medicine delivered services for older people. Age Ageing. 2019;48:458–62.
doi: 10.1093/ageing/afy218
pubmed: 30624577
Sbai M, Martin F, Partridge J, Dhesi J. Comprehensive geriatric assessment (CGA) in the perioperative setting: the current state of play. J R Coll Physicians Edinb. 2020;50(4):356–8.
doi: 10.4997/jrcpe.2020.401
pubmed: 33469607
Partridge JS, Harari D, Martin FC, et al. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. BJS. 2017;104:679–87.
doi: 10.1002/bjs.10459
Shipway D, Koizia L, Winterkorn N, Fertleman M, Ziprin P, Moorthy K. Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery. Future Healthc J. 2018;5:108–16.
doi: 10.7861/futurehosp.5-2-108
pubmed: 31098544
pmcid: 6502563
Thillainadesan J, Aitken SJ, Monaro SR, et al. Geriatric comanagement of older vascular surgery inpatients reduces Hospital-Acquired geriatric syndromes. JAMDA. 2022;23(4):589–95.
pubmed: 34756839
Braude P, Goodman A, Elias T, et al. Evaluation and establishment of a ward-based geriatric liaison service for older urological surgical patients: proactive care of older people undergoing surgery (POPS)-Urology. BJU Int. 2017;120(1):123–9.
doi: 10.1111/bju.13526
pubmed: 27167854
Thu K, Nguyen HP, Gogulan T, et al. Care of older people in surgery for general surgery: a single centre experience. ANZ J Surg. 2021;91(5):890–5.
doi: 10.1111/ans.16728
pubmed: 33792142
Ibitoye SE, Braude P, Carter B, et al. Geriatric assessment is associated with reduced mortality at 1-year for older adults admitted to a major trauma centre: a prospective observational study. Ann Surg. 2023;277:343–9.
doi: 10.1097/SLA.0000000000005092
pubmed: 36745762
Vilches-Moraga A, Fox J. Geriatricians and the older emergency general surgical patient: proactive assessment and patient centred interventions. Salford-POP-GS. Aging Clin Exp Res. 2018;30:277–82.
doi: 10.1007/s40520-017-0886-5
pubmed: 29411329
pmcid: 5856886
Partridge JS, Healey A, Modarai B, Harari D, Martin FC, Dhesi JK. Preoperative comprehensive geriatric assessment and optimisation prior to elective arterial vascular surgery: a health economic analysis. Age Ageing. 2021;50:1770–7.
doi: 10.1093/ageing/afab094
pubmed: 34120179
Loh M. Perioperative Care of Older People. 2022. https://anzsgm.org/wp-content/uploads/2022/05/ANZSGM-Position-Statement-Perioperative-Care-of-Older-People_-FINAL.pdf . Accessed 8 February 2023.
Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal Perioperative Management of the geriatric patient: a best practices Guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222:930–47.
doi: 10.1016/j.jamcollsurg.2015.12.026
pubmed: 27049783
Skivington K, Matthews L, Simpson SA, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061.
doi: 10.1136/bmj.n2061
pubmed: 34593508
pmcid: 8482308
Horton T, Illingworth J, Warburton W. The spread challenge. How to support the successful uptake of innovations and improvements in health care. Health Foundation. 2018. https://www.health.org.uk/publications/the-spread-challenge . Accessed 1 March 2023.
Jasper EV, Dhesi JK, Partridge JS, Sevdalis N. Scaling up perioperative medicine for older people undergoing surgery (POPS) services; use of a logic model approach. Clin Med (Lond). 2019;19:478–84.
doi: 10.7861/clinmed.2019-0223
pubmed: 31732589
May CR, Johnson M, Finch T. Implementation, context and complexity. Implement Sci. 2016;11:1–12.
doi: 10.1186/s13012-016-0506-3
Thillainadesan J, Hilmer SN, Fleury AM, Naganathan V. New horizons in the perioperative care of older adults. Age Ageing. 2022;51:afab245.
doi: 10.1093/ageing/afab245
pubmed: 35134849
Dhesi J, Moonesinghe SR, Partridge J. Comprehensive Geriatric Assessment in the perioperative setting; where next? Age Ageing. 2019;48(5):624–7.
doi: 10.1093/ageing/afz069
pubmed: 31147709
de Las Casas R, Meilak C, Whittle A, et al. Establishing a perioperative medicine for older people undergoing surgery service for general surgical patients at a district general hospital. Clin Med (Lond). 2021;21:e608.
doi: 10.7861/clinmed.2021-0356
Waring J, Martin GP, Hartley P, Partridge JS, Dhesi JK. Implementing a perioperative care of older people undergoing surgery (POPS) service: findings from a multi-site qualitative implementation study. Age Ageing. 2023;52:afad149.
doi: 10.1093/ageing/afad149
pubmed: 37566561
pmcid: 10418147
Yin RK. Case study research: design and methods. Thousand Oaks, CA: Sage Publications, Inc; 2003.
Schofield JW. Increasing the generalizability of qualitative research. In: Gomm R, Hammersley M, Foster P, editors. Case study method. SAGE; 2000.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.
doi: 10.1093/intqhc/mzm042
pubmed: 17872937
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:1–15.
doi: 10.1186/1748-5908-4-50
Carter JE, Pyati S, Kanach FA, et al. Implementation of perioperative music using the consolidated framework for implementation research. Anesth Analg. 2018;127(3):623–31.
doi: 10.1213/ANE.0000000000003565
pubmed: 29905616
Kakar E, van Ruler O, van Straten B, et al. Implementation of music in colorectal perioperative standard care—barriers and facilitators among patients and healthcare professionals. Colorectal Dis. 2022;24(7):868–75.
doi: 10.1111/codi.16102
pubmed: 35194930
pmcid: 9544166
Crain N, Qiu C-Y, Moy S, et al. Implementation science for the adductor canal block: a new and adaptable methodology process. World J Orthop. 2021;12(11):899.
doi: 10.5312/wjo.v12.i11.899
pubmed: 34888150
pmcid: 8613678
Deftereos I, Hitch D, Butzkueven S, et al. Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a mixed-methods analysis of implementation using the Consolidated Framework for implementation research. BMC Health Serv Res. 2022;22(1):256.
doi: 10.1186/s12913-022-07466-9
pubmed: 35209897
pmcid: 8876395
Lane-Fall MB, Beidas RS, Pascual JL, et al. Handoffs and transitions in critical care (HATRICC): protocol for a mixed methods study of operating room to intensive care unit handoffs. BMC Surg. 2014;14(1):1–11.
doi: 10.1186/1471-2482-14-96
Lambert-Kerzner AC, Aasen DM, Overbey DM, et al. Use of the consolidated framework for implementation research to guide dissemination and implementation of new technologies in surgery. J Thorac Dis. 2019;11(Suppl 4):S487.
doi: 10.21037/jtd.2019.01.29
pubmed: 31032067
pmcid: 6465432
The NHS Constitution for England. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england . Accessed 20 September 2022.
Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide 149. Med Teach. 2023;45(3):241–51.
doi: 10.1080/0142159X.2022.2057287
Barry CA, Britten N, Barber N, Bradley C, Stevenson F. Using reflexivity to optimize teamwork in qualitative research. Qual Health Res. 1999;9(1):26–44.
doi: 10.1177/104973299129121677
pubmed: 10558357
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629.
doi: 10.1111/j.0887-378X.2004.00325.x
pubmed: 15595944
pmcid: 2690184
Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. BMJ Qual Saf. 1998;7(3):149–58.
doi: 10.1136/qshc.7.3.149
Plsek PE, Wilson T. Complexity, leadership, and management in healthcare organisations. BMJ. 2001;323(7315):746–9.
doi: 10.1136/bmj.323.7315.746
pubmed: 11576986
pmcid: 1121291
Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14:1–15.
doi: 10.1186/s13012-019-0892-4
Hull L, Goulding L, Khadjesari Z, et al. Designing high-quality implementation research: development, application, feasibility and preliminary evaluation of the implementation science research development (ImpRes) tool and guide. Implement Sci. 2019;14:1–20.
doi: 10.1186/s13012-019-0897-z
Hunter SC, Kim B, Kitson AL. Mobilising implementation of i-PARIHS (Mi-PARIHS): development of a facilitation planning tool to accompany the Integrated Promoting Action on Research Implementation in Health Services framework. Implement Sci Commun. 2023;4:1–12.
doi: 10.1186/s43058-022-00379-y
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17:1–16.
doi: 10.1186/s13012-022-01245-0