SAGES SMART Implementation Timeline

SAGES SMART steps for creation and implementation of a care pathway

Proposed timeline

Actions

Suggestions

2 weeks

  • Map all care processes involved in perioperative patient care

  • Assemble a multidisciplinary team.

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

2 weeks

  • Scheduled meetings for the next 3-4 months

  • Decide which audit indicators you would like to collect, how they will be collected, and by whom. Start collecting data several months before implementation so can monitor results

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.

0-2 months

  • Review the literature for best practices and guidelines in perioperative care

  • Write a draft of your protocol/care pathway. Adapt the evidence to your setting. It is not always feasible or doable to insert all enhanced recovery elements into your protocol.

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

  • Present drafts to multidisciplinary team and modify as needed.

  • Repeat process until consensus is reached on all pathway elements

  • Stakeholders sign off on final draft.

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  • Send to approval committees (if any)

3-4 months

  • Create the patient education booklet.

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.

It should:

  • Be written in plain language aiming with a literacy level of grade 5 or 6.

  • Have plenty of white space. This encourages patients to read.

  • Have short sentences and use point form as much as possible.

  • Add meaningful images to help increase comprehension.

6 months

  • Once all documents are approved education sessions should be given to front line staff a few weeks prior to launch date

  • Set a launch date and communicate the launch date

  • Continue collecting and analyzing audit data.

Performance management helps to develop a culture of accountability.

3 months post launch

  • Gather all stakeholders for presentation of data and discussions of barriers, remaining challenges and facilitators.

Share pre and post implementation data with frontline staff.

3 months after launch

Evaluate patient booklet

7-10 patients



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