SAGES SMART Implementation Timeline

• Map all care processes involved in perioperative patient care

• Assemble a multidisciplinary team.

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

• 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

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.

• 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.

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.

• 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.

• Send to approval committees (if any)

• Create the patient education booklet.

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.

• 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.

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