Sustaining a clinical practice improvement project in elective major hepatopancreatobiliary surgery during the height of the Coronavirus disease 2019 (COVID-19) pandemic

Abstract

Purpose: Early mobilization post-operatively reduces morbidity. However, compliance has been reported to be poor. This is a one-year follow-up post implementation of our clinical practice improvement project (CPIP) to improve post-operative mobilization rate during the Coronavirus Disease 2019 (COVID-19) pandemic. Method: This is a descriptive study on patients who underwent elective major hepatopancreatobiliary surgery one year (Oct 2019-Sep 2020) following the implementation (May-Sep 2019) of our CPIP to achieve successful mobilization (defined as ≥30m on post-operative day (POD) 2) with a target mobilization rate of 75% across all patients. Our data is categorized into (a) baseline data (pre-implementation from Jan-Apr 2019) (b) implementation phase (c) sustainability phase (pre-COVID-19) and (d) sustainability phase (during COVID-19). Results: 152 patients underwent elective major hepatopancreatobiliary surgery from Jan 2019 to Sep 2020; 38(25.0%), 33(21.7%), 45(29.6%) and 36(23.7%) patients underwent surgery in the pre-implementation, implementation, sustainability (pre-COVID-19) and sustainability phase (during COVID-19) respectively. Majority of the patients were male (65.1%). Median length of hospitalisation stay was 6 days (interquartile range 5-12). There were 102(67.1%) patients who had On-Q PainBuster insertion intra-operatively. Mean pain score was 2.7±1.1 on POD1 and 2.0±1.6 on POD2. During the sustainability phase (both pre-COVID-19 and COVID-19), target mobilization rate of ≥75% was achieved for 4 of 6 months (66.7%), with a median target mobilization rate of 94.4% and 79.2% respectively. This is summarized in Figure 1 Conclusion: Our study shows the sustainability of our CPIP in improvement of target mobilization rate one year following implementation even during the COVID-19 pandemic.