Putting patient value first: Using a modified nominal group technique for the implementation of enhanced recovery after cardiac surgery recommendationsCentral MessagePerspective
Mudra G. Dave, BKin,
Anna M. Chudyk, MSc, PhD,
Nebojša Oravec, BSc,
David E. Kent, MSc,
Todd A. Duhamel, MSc, PhD,
Annette S.H. Schultz, RN, PhD,
Rakesh C. Arora, MD, PhD
Affiliations
Mudra G. Dave, BKin
Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada
Anna M. Chudyk, MSc, PhD
St Boniface Research Centre, Health Services & Structural Determinants of Health Research, Winnipeg, Manitoba, Canada; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Nebojša Oravec, BSc
Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
David E. Kent, MSc
Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada
Todd A. Duhamel, MSc, PhD
Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, Alberchtsen Research Centre, St Boniface Hospital, Winnipeg, Manitoba, Canada
Annette S.H. Schultz, RN, PhD
St Boniface Research Centre, Health Services & Structural Determinants of Health Research, Winnipeg, Manitoba, Canada; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Rakesh C. Arora, MD, PhD
Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, Alberchtsen Research Centre, St Boniface Hospital, Winnipeg, Manitoba, Canada; Section of Cardiac Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Address for reprints: Rakesh C. Arora, MD, PhD, IH Asper Clinical Research Institute, St Boniface Hospital, CR3015–369 Taché Ave, Winnipeg, MB, Canada R2H 2A6.
Objective: In 2019, the Society for Enhanced Recovery After Cardiac Surgery (ERAS-CS) published perioperative guidelines to optimize the care of patients undergoing cardiac surgery. For centers with limited capacity, a sequential approach to the implementation of the full guidelines may be more feasible. Therefore, we aimed to explore the priority of implementation of the ERAS-CS guideline recommendations from a patient and caregiver perspective. Methods: Using a modified nominal group technique, individuals who previously underwent cardiac surgery and their caregivers ranked ERAS-CS recommendations within 3 time points (ie, preoperative, intraoperative, and postoperative) and across 2 to 3 voting rounds. Final round rankings (median, mean and first quartile) were used to determine relative priorities. Results: Seven individuals (5 patients and 2 caregivers) participated in the study. Patient engagement tools (2, 2.29, and 1.50), surgical site infection reduction (2, 1.67, and 1.25), and postoperative systematic delirium screening (1, 2.43, and 1.00) were the top-ranked ERAS-CS recommendations in the preoperative, intraoperative, and postoperative time points, respectively. Conclusions: Exploration of patient and caregiver priorities may provide important insights to guide the healthcare team with clinical pathway development and implementation. Further study is needed to understand the impact of the integration of patient and caregiver values on effective and sustainable clinical pathway implementation.
