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A Multifaceted Knowledge Translation Strategy Can Increase Compliance with Guideline Recommendations for Mechanical Bowel Preparation

  • 2014 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

The successful transfer of evidence into clinical practice is a slow and haphazard process. We report the outcome of a 5-year knowledge translation (KT) strategy to increase adherence with a clinical practice guideline (CPG) for mechanical bowel preparation (MBP) for elective colorectal surgery patients. A locally tailored CPG recommending MBP practices was developed. Data on MBP practices were collected at six University of Toronto hospitals before CPG implementation as well as after two separate KT strategies. KT strategy #1 included development of the CPG, education by opinion leaders, reminder cards, and presentations of data. KT strategy #2 included selection of hospital champions, development of communities of practice, education, reminder cards, electronic updates, pre-printed standardized orders, and audit and feedback. A total of 744 patients (400 males, 344 females, mean age 57.0) were included. Compliance increased from 58.6 to 70.4 % after KT strategy #1 and to 81.1 % after KT strategy #2 (p < 0.001). Using a tailored KT strategy, increased compliance was observed with CPG recommendations over time suggesting that a longitudinal KT strategy is required to increase and sustain compliance with recommendations. Furthermore, different strategies may be required at different times (i.e., educational sessions initially and reminders and standardized orders to maintain adherence).

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Acknowledgments

This paper is supported in part by a grant from the Council of Academic Hospitals of Ontario.

Author information

Authors and Affiliations

  1. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Cagla Eskicioglu

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Emily Pearsall, Mary-Anne Aarts, Allan Okrainec & Robin S McLeod

  3. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Emily Pearsall & Robin S McLeod

  4. Zane Cohen Digestive Diseases Research Center, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada

    Emily Pearsall & Robin S McLeod

  5. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    Emily Pearsall & Robin S McLeod

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    J. Charles Victor

  7. Toronto East General Hospital, Toronto, ON, Canada

    Mary-Anne Aarts

  8. Toronto Western Hospital, University Health Network, Toronto, ON, Canada

    Allan Okrainec

Authors
  1. Cagla Eskicioglu
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  2. Emily Pearsall
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  3. J. Charles Victor
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  4. Mary-Anne Aarts
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  5. Allan Okrainec
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  6. Robin S McLeod
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Corresponding author

Correspondence to Robin S McLeod.

Additional information

Discussant

Dr. Alessandro Fichera (Seattle, WA):

This is a great example of system wide policy implementation strategy to standardization of practice, something that is currently front and center in the US as we face a new era in health care management and delivery. We have all experienced the delay in implementation of level I evidence into clinical practice and its impacts on quality, cost of care and delivery. The results obtained in this study in just 5 years are remarkable. The approach was very well planned, the interventions and the data collection properly timed.

Did the authors have an opportunity to look at the downstream effect of your intervention? i.e. wound infection, anastomotic leaks, length of stay, cost, etc.? What was the administrative support needed to implement such a long study and who “paid” for it? The data collection periods were relatively short, do you think the participants were more likely to be compliant knowing they were “watched”? Are you still collect compliance data to see if the change in practice observed has become a change in culture?

Closing Discussant

Dr. Eskicioglu:

Thank you for your comments and feedback. Please see below for the responses to your questions.

We did not collect clinical outcome data, such as SSI rates, anastomotic leak rates etc., during our first two data collection periods. The first two data collection periods were part of a Master’s thesis project and we felt that adding more clinical outcomes was beyond the scope of the project. However, since the third data collection was part of a larger enhanced recovery after surgery program, we have collected data on these clinical endpoints. We have plans to publish some of these outcome data comparing patients who have had care in compliance with the guideline recommendations and those who have not.

At each site where we collected data, a research coordinator was hired to facilitate data collection. This assistant was initially supported by funding from a grant but it is our hope that each individual institution will continue to support a research coordinator once the grant funding has run out.

The first two data collection periods were short, again because they were part of a thesis project, and there was likely some element of the “Hawthorne effect”, with surgeons increasing compliance because they knew they were being watched. However, the data collected after the second intervention demonstrates that the increase in compliance has been sustained. We are continuing to collect data now further investigate if these changes will continue to persist.

Dr. Robin McLeod holds the Angelo and Alfredo De Gasperis Families Chair in Colorectal Cancer and IBD Research.

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Eskicioglu, C., Pearsall, E., Victor, J. et al. A Multifaceted Knowledge Translation Strategy Can Increase Compliance with Guideline Recommendations for Mechanical Bowel Preparation. J Gastrointest Surg 19, 39–45 (2015). https://doi.org/10.1007/s11605-014-2641-y

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  • DOI: https://doi.org/10.1007/s11605-014-2641-y

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