Abstract
BackgroundRisk assessment in surgery is essential to guide treatment decisions but is highly variable in practice. Providing formal preoperative risk assessment to surgical teams and patients may optimize understanding of risk. Implementation of the Surgical Risk Preoperative Assessment System (SURPAS), an innovative real time, universal, preoperative tool providing individualized risk assessment, may enhance informed consent and reduce adverse outcomes. To ensure optimal development and implementation of SURPAS we performed an in-depth pre-implementation evaluation of SURPAS at an academic tertiary referral center in Colorado.MethodsFour focus groups with 24 patients, three focus groups with 29 surgical providers and clinic administrators, and five individual interviews with administrative officials were conducted to elicit their perspectives about the development and implementation of SURPAS. Qualitative data collection and analyses, utilizing a Matrix Analysis approach were used to explore insights regarding SURPAS.ResultsParticipants were positive about SURPAS and provided suggestions to improve and address concerns regarding it. For healthcare personnel three major themes emerged: 1) The SURPAS tool - Important work especially for high risk patients, yet not a substitute for clinical judgment; 2) Benefits of SURPAS to the risk assessment process - Improves the processes, enhances patients’ participation in shared decision-making process, and creates a permanent record; and 3) Facilitators and barriers of implementation of SURPAS - Easy to incorporate into clinical practice in spite of surgical providers’ resistance to adoption of new technology. For patients three major themes emerged: 1) Past experience of preoperative risk assessment discussions – Patients were not made aware of possible complications that occurred; 2) The SURPAS tool - All patients liked SURPAS and believed having printed material would be useful to guide discussions and facilitate remembering conversations with the providers; and 3) Potential concerns with having risk assessment information – Patients were mixed in deciding to have an operation with high risks.ConclusionsSystematically capturing data from the beginning of the implementation process from key stakeholders (patients, surgical providers, clinical staff, and administrators) that includes adaptations to the tool and implementation process will help to inform pragmatic approaches for implementing the SURPAS tool in various settings, scaling-up, and sustaining it.
Highlights
Risk assessment in surgery is essential to guide treatment decisions but is highly variable in practice
Perioperative complications from major surgical procedures occur in approximately 13% of patients and all-cause mortality in 1.4% of patients within 30 days after surgery, based on the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) dataset
Formal risk assessment tools exist, many based on ACS NSQIP data, but are not widely used perhaps because they are seldom easy to use or not integrated into clinical workflow, i.e., the electronic health record (EHR) [5, 6]
Summary
Risk assessment in surgery is essential to guide treatment decisions but is highly variable in practice. Perioperative complications from major surgical procedures occur in approximately 13% of patients and all-cause mortality in 1.4% of patients within 30 days after surgery, based on the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) dataset. These include infectious, cardiac, bleeding, renal, pulmonary, venous thromboembolic, and neurological complications, and death [1]. In addition to the detrimental impact that these adverse occurrences have on patients’ length and quality of life [2], healthcare costs of hospitalizations for patients experiencing perioperative complications can be up to five times that of patients without complications [3, 4] Reduction of these complications is of great importance to patients, their families, surgical providers, healthcare payers, and society. We argue that the generation of preoperative risk assessment tools needs to be quick and easy to use, integrated into the EHR, provide reliable and meaningful estimates of risk, encompass many different types of surgery and complications, be based on readily available preoperative data, and be updated periodically [6]
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