Table 3 Methods and instruments for measuring the effects of a multifaceted implementation strategy to implement the Dutch national perioperative safety guidelines
Outcome variable | Data source (type of measurement) | Frequency of measurement and sample size per measurement | Moment of measurement | Unit of analysis |
|---|---|---|---|---|
Primary outcome (guideline adherence measured by an indicator set of nine process and structure indicators) | Â | Â | Â | Â |
Completion of the total STOP bundle (seven separate stop moments in the perioperative care process), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Availability of a protocol on antibiotic use | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Timely administration of antibiotic prophylaxis, % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Availability of a protocol on anticoagulant use | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Availability of a protocol on responsibilities regarding maintenance of medical equipment | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Availability of a protocol on (performing) prospective risk analysis of medical equipment | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Availability of OR regulations | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Presence of a surveillance system for postoperative wound infections | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Presence of a morbidity and mortality registration | Short questionnaire on the underlying items of the structure indicators | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1 | −3 months, +4 months, +11 months and +18 months | Hospital |
Secondary outcomes | Â | Â | Â | Â |
Complications (in-hospital), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Postoperative wound infections (in-hospital), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Postoperative mortality (in-hospital), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Length of hospital stay, number of days | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Unscheduled transfer to the ICU (within 30 days after the initial surgery), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Non-elective hospital readmission (within 30 days after the initial surgery), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Unscheduled reoperation (within 30 days after the initial surgery), % patients | Retrospective patient record review in the hospital information systems | 4 (T0 (before), T1, T2, T3 (after) measurement) N = 1,800 | −3 months, +4 months, +11 months and +18 months | Patient |
Determinants of change | Â | Â | Â | Â |
Team climate | Team climate inventory | 1 (T0 (before) measurement) | −3 months | Professional |
Patients safety culture | Hospital survey on patient safety culture | 1 (T0 (before) measurement) | −3 months | Professional |
Barriers and facilitators of guideline adherence | Questionnaire | 1 (before the start of the implantation period in the concerning group of hospitals) N ≥ 7 (at least one surgeon, anesthesiologist, OR, anesthesia, recovery, and ward nurse, and ICU employee) | Variable (depending on the start of the implementation period) | Professional |