Introduction
A multistakeholder partnership among the Agency for Healthcare Research and Quality (AHRQ) (funder), the American College of Surgeons (ACS), and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), a national effort to assist hospitals in implementing pathways for surgical patients that incorporates evidence-based practices to >750 hospitals across multiple surgical procedures over the next 5 years. This program will cover 5 surgical areas including colorectal surgery (CRS), orthopedics, gynecology, bariatrics, and emergency general surgery. This expansive project aims to assist hospitals in improving perioperative care through implementation of evidence-based enhanced recovery pathways (ERP).AJOG at a Glance
To review the literature on enhanced recovery pathways in gynecologic surgery and identify the evidence-based components that will comprise the pathway for gynecologic surgery within the Safety Program for Improving Surgical Care and Recovery.
Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.
This study provides a detailed evidence-based enhanced recovery pathway specifically focused on gynecologic surgery that will serve as the reference pathway during the Agency for Healthcare Research and Quality national effort to assist hospitals in implementing evidence-based pathways for surgical patients to >750 hospitals across multiple surgical procedures including gynecologic surgery over the next 5 years.
ERP have reduced complications, shortened length of stay, improved patient satisfaction, and reduced costs for a variety of operations across specialties, including gynecology. The effectiveness of these programs is directly related to a hospitals’ ability to promote high compliance with each pathway process. Adherence to these pathways appears to have a dose-response effect on clinical outcomes.1 Successful and sustainable implementation goes beyond protocol development, requiring integration across patient units, timely feedback of performance data sharing, senior executive support, as well as ongoing educational sessions.2 As such, the Safety Program for ISCR will provide extensive resources beyond the ERP including access to outcome registries, performance benchmarking, educational materials, leadership training, and contemporary implementation science tools.
The objective of this article is to systematically review the literature supporting the individual components that most commonly comprise the ERP in gynecologic surgery and develop a comprehensive AHRQ Safety Program for ISCR pathway tailored to gynecologic surgery for widespread dissemination and implementation.