Implementation of consensus-based perioperative care pathways to reduce clinical variation for elective surgery in an Australian private hospital: a mixed-methods pre–post study protocol
Jeffrey Braithwaite,
Peter D Hibbert,
Kate Churruca,
Louise A Ellis,
Janet C Long,
Gaston Arnolda,
Mitchell N Sarkies,
Emilie Francis-Auton,
Andrew Partington,
Karen Hutchinson,
David Gillatt,
Luke Testa,
Lisa Pagano,
Cameron Hemmert,
Andrew Hirschhorn,
Graham Gumley,
Cliff Hughes,
Romika Patel
Affiliations
Jeffrey Braithwaite
1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
Peter D Hibbert
1 Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
Kate Churruca
1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
Louise A Ellis
Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
Janet C Long
1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
Gaston Arnolda
1 Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Mitchell N Sarkies
1 School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Emilie Francis-Auton
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
Andrew Partington
8 Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
Karen Hutchinson
1 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
David Gillatt
MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Luke Testa
Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Lisa Pagano
postdoctoral fellow
Cameron Hemmert
School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Andrew Hirschhorn
MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Graham Gumley
MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Cliff Hughes
Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Romika Patel
Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
Introduction Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact.Methods A mixed-methods Effectiveness-Implementation Hybrid (type III) pre–post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The individual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15–20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways.Ethics and dissemination This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders.
