What does this research mean for the field?

A combined top-down and bottom-up collaborative methodology successfully embedded a large-scale enhanced recovery programme in elective surgery across the southeast region of England. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 1, 2017BMJ Open QualityOpen Access

Achieving a ‘top-down’ change agenda by driving and supporting a collaborative ‘bottom-up’ process: case study of a large-scale enhanced recovery programme

Q: What is the clinical evidence from this study?

Study design: Other. Population: Elective surgery (colorectal, gynaecology, orthopaedics). Intervention: Enhanced recovery (ER) programme (collaborative top-down and bottom-up implementation) vs. Baseline practice. Primary outcome: Care bundle compliance and length of stay.

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Key result

Collaborative enhanced recovery implementation boosts care bundle compliance and shortens hospital stay.

Population

10 acute Trusts and 9 independent sector providers in the Kent, Surrey and Sussex region of England…

Design

Other

Follow-up

4 years (May 2011 to December 2015)

Authors

FOFatai Ogunlayi PBPhilip Britton

Discussion

Member takes

Implication

Supports collaborative enhanced recovery implementation regionally; leaves open randomized confirmation of benefits and generalizability.

Structured PICO

Population

A regional quality improvement initiative involving 10 acute Trusts and 9 independent sector providers in southeast England implementing an enhanced recovery programme for elective surgeries over 4 years.

Intervention

Large-scale enhanced recovery (ER) programme combining top-down coordination with bottom-up collaborative working

Outcome

Care bundle compliance and length of stay (LOS)

A combined top-down and bottom-up approach successfully embedded a large-scale enhanced recovery programme across multiple hospitals, improving compliance and reducing length of stay.

Limitations

Lack of structured training in quality improvement tools and techniques.
Information cascade systems within individual Trusts were sometimes not robust.
Removal of financial incentives (CQUINs) led to a loss of momentum in some providers.
Lack of a formal cost-benefit analysis planned at the outset of the programme.
Lack of initial cost-benefit analysis planning

Cite This Study

Ogunlayi et al. (2017) studied Elective surgery (colorectal, gynaecology, orthopaedics). Enhanced recovery (ER) programme (collaborative top-down and bottom-up implementation) vs. Baseline practice was evaluated on Care bundle compliance and length of stay. A collaborative top-down and bottom-up implementation of an enhanced recovery programme successfully increased care bundle compliance and reduced length of stay across regional hospitals.

synapsesocial.com/papers/6a193e82cc4b10f5fb88baa6 https://doi.org/10.1136/bmjoq-2017-000008

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Achieving a ‘top-down’ change agenda by driving and supporting a collaborative ‘bottom-up’ process: case study of a large-scale enhanced recovery programme

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Achieving a ‘top-down’ change agenda by driving and supporting a collaborative ‘bottom-up’ process: case study of a large-scale enhanced recovery programme

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider