A bundled approach to care: reducing the incidence of postoperative pneumonia in patients undergoing hepatectomy and Whipple procedures

A bundled approach to care: reducing the incidence of postoperative pneumonia in patients undergoing hepatectomy and Whipple procedures

Can J Surg 2021;64(1):E9-E13 | PDF

Gifty Mahama, MN; Laavanyah Vigneswaran, MPH; Alice Silva, MPH; Azusa Maeda, PhD; Dalton-Grant Davis, RN; Lenore Thomas, RN, BSc; Beverly Barretto, RN; Sandra Weller, RN; Allan Okrainec, MD, MHPE; Joseph Gajasan, MN, MBA; Timothy Jackson, MD, MPH

Summary

Postoperative occurrence of pneumonia can increase lengths of stay, risk of morbidity and death and health care costs. At Toronto General Hospital, we identified a high incidence of postoperative pneumonia in patients undergoing hepatectomy and Whipple procedures in 2016. To reduce the incidence of postoperative pneumonia, we implemented an evidence-based bundle approach in 2017. The bundle included the following components: oral care, incentive spirometry, coughing and deep breathing, physical activity, elevation of the head of the bed, and patient and family education. In addition to the bundle components, we provided staff education and created patient education and monitoring tools to ensure competency and compliance with the bundle components. Data collected as part of the National Surgical Quality Improvement Program were reviewed to monitor progress. In this article, we discuss our approach, aimed to reduce the incidence of postoperative pneumonia and associated health care costs in the general surgery population.


Accepted Feb. 25, 2020

Acknowledgements: The authors thank MaryAnn Neary, the entire
9ES General Surgery Nursing Unit, the Early Mobility Program and
the Allied Health Care Team at Toronto General Hospital, University
Health Network.

Affiliations: From the Division of General Surgery, University Health Network, Toronto, Ont. (Mahama, Vigneswaran, Maeda, Davis, Thomas, Barretto, Weller, Okrainec, Gajasan, Jackson); the Infection Prevention and Control, University Health Network, Toronto, Ont. (Silva); and the Department of Surgery, University of Toronto, Toronto, Ont. (Okrainec, Jackson).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: 10.1503/cjs.016818

Correspondence to: T.D. Jackson, Toronto Western Hospital, University Health Network, 399 Bathurst St, Room 8MP-322, Toronto ON M5T 2S8, timothy.jackson@uhn.ca