SAGES SMART steps for creation and implementation of a care pathway
Understanding which areas/services are involved with preparing and caring for the perioperative patient will help identify and include all stakeholders.
You should have representation of everyone who interfaces with surgical patients: nursing (preop, postop), anaesthesia, surgery, nutritionist, physiotherapist, pharmacy
Team members must be able to represent their constituencies and act as change champions
These meetings should be held regularly (every week or every 2 weeks). This helps to give a sense of urgency and sets the momentum.
Length of stay is often collected. Consider collecting readmission within 30 days of discharge. Include a few key variances identifying common reasons for delays I discharge. This will help you decide where you should focus improvements. The documentation, monitoring, and evaluation of variances and outcomes are a key characteristic of a care pathway.
Hospital librarian is a good helpful resource for literature searches if available
Should include elements from all phases of perioperative care- preop, intraop and postop
Determine a target discharge date
Standard order sets decrease variability and include preoperative medication, postoperative medication and exit prescriptions.
Should also include medical orders for each day starting from the preoperative visit, postoperative day 0, postoperative 1 etc until target day of discharge.
Consider writing standards of nursing care for each day and an intraoperative guideline.
Avoid checkboxes. These orders are not a set of options to choose from depending on preference.
At 3 months
Educational material for patients and their families must be consistent with care pathway and aims to increase patient engagement and empowerment
Giving information about the surgery, the preparation and the expected goals after surgery are just a few of the areas that should be described.
The patient booklet should represent the pathway in lay format.
Performance management helps to develop a culture of accountability.
3 months post launch
Share pre and post implementation data with frontline staff.
3 months after launch
Evaluate patient booklet